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NPI Code Detail

MEDICARE: TROY WILSON CDCAII

MEDICARE: TROY WILSON CDCAII
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.193529OH
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922784610
Entity Type Code : Individual
Provider Name (Legal Business Name) : TROY WILSON CDCAII
Provider Business Mailing Address
First Line : 15256 COUNTY ROAD 274
Second Line :
City : COSHOCTON
State : OH
Zip : 43812-9787
Country : US
Telephone Number : 772-269-5491
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 : 800-480-7578
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2023
Last Update Date : 03/10/2026

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