GERALD LEE BACCUS

DAYTON, OH
NPI1073229001
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: OH  183243)
Enumeration Date2023-01-24
Last Update Date2023-01-24
Business Address
GERALD LEE BACCUS
2400 W STROOP RD
DAYTON, OH 45439-2041
Phone number: 614-634-0195
Mailing Address
GERALD LEE BACCUS
PO BOX 10232 SOUTH LUDLOW ST
DAYTON, OH 45402
Phone number: 937-559-2255
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