Provider Demographics
NPI:1033760376
Name:BOOTH, JOSHUA (CDCA I, BA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BOOTH
Suffix:
Gender:M
Credentials:CDCA I, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718-0056
Mailing Address - Country:US
Mailing Address - Phone:740-782-1407
Mailing Address - Fax:
Practice Address - Street 1:41418 STENGER ROAD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:OH
Practice Address - Zip Code:43718-4371
Practice Address - Country:US
Practice Address - Phone:740-782-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)