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1780158444
DERRELL ANTHONY FUQUA
DAYTON, OH
NPI
1780158444
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OH 169214)
Enumeration Date
2019-01-16
Last Update Date
2019-01-16
Business Address
DERRELL ANTHONY FUQUA Cdca
2529 BRIDGEPORT DR
DAYTON, OH 45406-1433
Phone number: 937-278-0869
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Mailing Address
DERRELL ANTHONY FUQUA Cdca
2529 BRIDGEPORT DR
DAYTON, OH 45406-1433
Phone number: 937-278-0869
Copy
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