DERRELL ANTHONY FUQUA

DAYTON, OH
NPI1780158444
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OH  169214)
Enumeration Date2019-01-16
Last Update Date2019-01-16
Business Address
DERRELL ANTHONY FUQUA Cdca
2529 BRIDGEPORT DR
DAYTON, OH 45406-1433
Phone number: 937-278-0869
Mailing Address
DERRELL ANTHONY FUQUA Cdca
2529 BRIDGEPORT DR
DAYTON, OH 45406-1433
Phone number: 937-278-0869
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