Provider Demographics
NPI:1003314113
Name:MUHAMMAD, LARRY (CDCA)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MUHAMMAD
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 1:1238 COBB AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-1904
Mailing Address - Country:US
Mailing Address - Phone:937-215-0176
Mailing Address - Fax:
Practice Address - Street 1:1238 COBB AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-1904
Practice Address - Country:US
Practice Address - Phone:937-215-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHAPS.004553175T00000X
OHCDCA.110082101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist