Provider Demographics
NPI:1366003089
Name:WILSON, DENNY MICHAEL (CDCA/OPRS)
Entity Type:Individual
Prefix:
First Name:DENNY
Middle Name:MICHAEL
Last Name:WILSON
Suffix:
Gender:M
Credentials:CDCA/OPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 FREDERICK BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3329
Mailing Address - Country:US
Mailing Address - Phone:330-459-5563
Mailing Address - Fax:
Practice Address - Street 1:1445 FREDERICK BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3329
Practice Address - Country:US
Practice Address - Phone:330-459-5563
Practice Address - Fax:888-422-2759
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001303175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH001303OtherOHIO PEER RECOVERY SUPPORTER