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NPI Code Detail

MEDICARE: WILLARD DAN DEARMOND JR.

MEDICARE: WILLARD DAN DEARMOND JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerI.2607960OH
2101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162479OH

General Provider Information

NPI Number : 1053967240
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLARD DAN DEARMOND JR.
Provider Business Mailing Address
First Line : 2624 LEXINGTON AVE
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45505-2620
Country : US
Telephone Number : 937-328-5300
Fax Number : 937-322-4900
Provider Business Practice Location Address
First Line : 2624 LEXINGTON AVE
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45505-2620
Country : US
Telephone Number : 937-328-5300
Fax Number : 937-322-4900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 03/27/2026

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Directions to “ WILLARD DAN DEARMOND JR. ” Practice Location

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