Provider Demographics
NPI:1902391311
Name:PORTWOOD, JOSHUA K (CDCA)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:K
Last Name:PORTWOOD
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 1:7516 WOODLAND TRACE DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5226
Mailing Address - Country:US
Mailing Address - Phone:614-600-0146
Mailing Address - Fax:
Practice Address - Street 1:1900 BRICE RD.
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068
Practice Address - Country:US
Practice Address - Phone:614-239-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)