Basic Information
| Provider Information | |||||||||
| NPI: | 1285140491 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUDWIG | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CDCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 PARK AVE WEST | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195285993 | ||||||||
| FaxNumber: | 5675605483 | ||||||||
| Practice Location | |||||||||
| Address1: | 2775 STATE ROUTE 39 | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197473322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2017 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDCA.166497 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.