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NPI Code Detail

MEDICARE: KENTON DURHAM

MEDICARE: KENTON DURHAM
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) CounselorCDCA.182506OH
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.186062OH
3101Y00000XCounselorM.2400388-TRNEOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326755729
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENTON DURHAM
Provider Business Mailing Address
First Line : 2960 W ENON RD
Second Line :
City : XENIA
State : OH
Zip : 45385-8548
Country : US
Telephone Number : 937-272-4925
Fax Number : 937-984-4346
Provider Business Practice Location Address
First Line : 2960 W ENON RD
Second Line :
City : XENIA
State : OH
Zip : 45385-8548
Country : US
Telephone Number : 937-272-4925
Fax Number : 937-984-4346
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2022
Last Update Date : 05/07/2024

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Practice Location Address:
2960 W ENON RD
XENIA, OH
45385-8548
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1730592924 — NATHAN CRAGO LICDC
Practice Location Address:
2960 W ENON RD
XENIA, OH
45385-8548
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1043716798 — SARA KOLODZIEJSKI
Practice Location Address:
2960 W ENON RD
XENIA, OH
45385-8548
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Practice Fax:

Directions to “ KENTON DURHAM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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