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NPI Code Detail

MEDICARE: VEOMANY PHOUTHAVONG CDCA

MEDICARE: VEOMANY PHOUTHAVONG CDCA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor180611OH
2175T00000XPeer Specialist

General Provider Information

NPI Number : 1194474502
Entity Type Code : Individual
Provider Name (Legal Business Name) : VEOMANY PHOUTHAVONG CDCA
Provider Business Mailing Address
First Line : 4214 E MAIN ST
Second Line :
City : WHITEHALL
State : OH
Zip : 43213-3028
Country : US
Telephone Number : 614-697-1313
Fax Number :
Provider Business Practice Location Address
First Line : 4177 E BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-1217
Country : US
Telephone Number : 614-697-1313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2022
Last Update Date : 02/07/2023

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Directions to “ VEOMANY PHOUTHAVONG CDCA” Practice Location

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