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1073229001
GERALD LEE BACCUS
DAYTON, OH
NPI
1073229001
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OH 183243)
Enumeration Date
2023-01-24
Last Update Date
2023-01-24
Business Address
GERALD LEE BACCUS
2400 W STROOP RD
DAYTON, OH 45439-2041
Phone number: 614-634-0195
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Mailing Address
GERALD LEE BACCUS
PO BOX 10232 SOUTH LUDLOW ST
DAYTON, OH 45402
Phone number: 937-559-2255
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