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NPI Code Detail

MEDICARE: TINA NIMON CPRS, CDCA

MEDICARE: TINA NIMON CPRS, 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) Counselor
2175T00000XPeer Specialist

General Provider Information

NPI Number : 1821677295
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA NIMON CPRS, CDCA
Provider Business Mailing Address
First Line : 104 SPINK ST
Second Line :
City : WOOSTER
State : OH
Zip : 44691-3652
Country : US
Telephone Number : 330-264-8498
Fax Number : 330-264-3777
Provider Business Practice Location Address
First Line : 104 SPINK ST
Second Line :
City : WOOSTER
State : OH
Zip : 44691-3652
Country : US
Telephone Number : 330-264-8498
Fax Number : 330-264-3777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2021
Last Update Date : 03/19/2026

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