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NPI Code Detail

MEDICARE: MRS. DENITA D DYDASCO M.ED., LICDC-CS

MEDICARE: MRS. DENITA D DYDASCO M.ED., LICDC-CS
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) Counselor1129KY
2101YP2500XProfessional CounselorKY-1160KY
3101YA0400XAddiction (Substance Use Disorder) Counselor101034OH

General Provider Information

NPI Number : 1831431659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DENITA D DYDASCO M.ED., LICDC-CS
Provider Business Mailing Address
First Line : 400 E STATE ST STE D
Second Line :
City : ATHENS
State : OH
Zip : 45701-1870
Country : US
Telephone Number : 866-534-2639
Fax Number :
Provider Business Practice Location Address
First Line : 400 E STATE ST STE D
Second Line :
City : ATHENS
State : OH
Zip : 45701-1870
Country : US
Telephone Number : 866-534-2639
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2013
Last Update Date : 03/31/2025

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Directions to “ MRS. DENITA D DYDASCO M.ED., LICDC-CS” Practice Location

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