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NPI Code Detail

MEDICARE: MR. RICHARD L CALVIN LICDC, LISW

MEDICARE: MR. RICHARD L CALVIN LICDC, LISW
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) CounselorI-0003145OH

General Provider Information

NPI Number : 1972606770
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD L CALVIN LICDC, LISW
Provider Business Mailing Address
First Line : 2303 WALLER ST
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-2968
Country : US
Telephone Number : 740-354-6685
Fax Number : 740-354-5061
Provider Business Practice Location Address
First Line : 1634 11TH ST
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-4526
Country : US
Telephone Number : 740-354-6685
Fax Number : 740-354-5061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2006
Last Update Date : 07/08/2007

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