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NPI Code Detail

MEDICARE: MR. ANTWON E ELIJAH I QMHS/CMS

MEDICARE: MR. ANTWON E ELIJAH I QMHS/CMS
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
11041C0700XClinical Social WorkerS.1800373-TRNEOH
2101YM0800XMental Health Counselor
3101YA0400XAddiction (Substance Use Disorder) Counselor
4104100000XSocial Worker

General Provider Information

NPI Number : 1588139125
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTWON E ELIJAH I QMHS/CMS
Provider Business Mailing Address
First Line : 813 TROY ST
Second Line :
City : DAYTON
State : OH
Zip : 45404-1852
Country : US
Telephone Number : 937-982-1500
Fax Number :
Provider Business Practice Location Address
First Line : 813 TROY ST
Second Line :
City : DAYTON
State : OH
Zip : 45404-1852
Country : US
Telephone Number : 937-982-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2018
Last Update Date : 02/13/2026

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