Provider Demographics
NPI:1437934866
Name:DURHAM, ADAM JOHN (CDCA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOHN
Last Name:DURHAM
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 BUSCH BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2587
Mailing Address - Country:US
Mailing Address - Phone:614-987-5003
Mailing Address - Fax:
Practice Address - Street 1:6161 BUSCH BLVD STE 290
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2587
Practice Address - Country:US
Practice Address - Phone:614-987-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185165101YA0400X
OHAPS.004048175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist