Basic Information
| Provider Information | |||||||||
| NPI: | 1942880703 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN OHIO COUNSELING AND SOBER LIVING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451441559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375444020 | ||||||||
| FaxNumber: | 9375444009 | ||||||||
| Practice Location | |||||||||
| Address1: | 607 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451441559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375444020 | ||||||||
| FaxNumber: | 9375444009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2021 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LATHAM | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING/CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9375444020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Community Health Worker |
No ID Information.