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NPI Code Detail

MEDICARE: OCTAVIA JOY WORKMAN

MEDICARE: OCTAVIA JOY WORKMAN
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.188439OH

General Provider Information

NPI Number : 1457159311
Entity Type Code : Individual
Provider Name (Legal Business Name) : OCTAVIA JOY WORKMAN
Provider Business Mailing Address
First Line : 8785 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6209
Country : US
Telephone Number : 440-701-6590
Fax Number :
Provider Business Practice Location Address
First Line : 8785 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6209
Country : US
Telephone Number : 440-701-6590
Fax Number : 440-701-8115
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2025
Last Update Date : 03/06/2025

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