Provider Demographics
NPI:1598283095
Name:DYER, KATIE JO (LCDC III)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:DYER
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14572 US HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9373
Mailing Address - Country:US
Mailing Address - Phone:740-835-8531
Mailing Address - Fax:
Practice Address - Street 1:14572 US HIGHWAY 23 STE H
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9448
Practice Address - Country:US
Practice Address - Phone:740-835-8531
Practice Address - Fax:740-835-8531
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)