Basic Information
| Provider Information | |||||||||
| NPI: | 1770047409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDUFFIE | ||||||||
| FirstName: | HOMER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CDCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 547 E 11TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432112603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142244506 | ||||||||
| FaxNumber: | 6142910118 | ||||||||
| Practice Location | |||||||||
| Address1: | 547 E 11TH AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432112603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142244506 | ||||||||
| FaxNumber: | 6142910118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDCA.163178 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.