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General NPI Number Information
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NPI Number | 1598327405
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Entity Type | Organization
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Legal Business Name | ELIMINATING BARRIERS & CONQUERING GOALS LLC
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 4825 HASSAN CIR APT 2
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City | DAYTON
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State | OH
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Zip | 45432-1315
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Country | US
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Telephone | 937-815-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 4825 HASSAN CIR APT 2
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City | DAYTON
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State | OH
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Zip | 45432-1315
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Country | US
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Telephone | 937-815-9035
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Fax |
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Authorized Official
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Title or Position | CHEMICAL DEPENDENCY COUNSELOR
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Name | MS. JUDITH MICHELE FOX-WILLIAMS
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Credential | LCDC II, OCPS
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Telephone | 937-815-9035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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