MEDICARE: DANELLE MATHIS CADACC II

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	C2-51384	IN

General Provider Information

NPI Number	:	1750064853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANELLE MATHIS CADACC II

Provider Business Mailing Address
First Line	:	3520 W TWO MILE HOUSE RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-9242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 W TWO MILE HOUSE RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-9242
Country	:	US
Telephone Number	:	812-803-2283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/08/2023

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