MEDICARE: JOYCE GIRARD

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	LICDC.161868	OH
2	104100000X	Social Worker	S.1700373	OH

General Provider Information

NPI Number	:	1962815142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE GIRARD

Provider Business Mailing Address
First Line	:	3833 LONGRIDGE DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-4531
Country	:	US
Telephone Number	:	937-207-2998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 E 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1850
Country	:	US
Telephone Number	:	937-387-6395
Fax Number	:

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

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	12/02/2019

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Directions to “ JOYCE GIRARD ” Practice Location

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