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General NPI Number Information
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NPI Number | 1760985790
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Entity Type | Individual
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Provider Name | JOHN WEBSTER NEE CDCA
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Gender | Male
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Dates
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Enumeration Date | 03/15/2018
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 1134 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631-2600
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Country | US
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Telephone | 740-446-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 BELMONT ST
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City | CHARLESTON
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State | WV
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Zip | 25314-1738
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Country | US
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Telephone | 602-736-6973
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 165254
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License Number State | OH
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