Provider Demographics
NPI:1134582901
Name:MYERS, GEORGE ALBERT JR (CDCA)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ALBERT
Last Name:MYERS
Suffix:JR
Gender:M
Credentials:CDCA
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:ALBERT
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:3021 VERNON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2417
Mailing Address - Country:US
Mailing Address - Phone:513-541-7099
Mailing Address - Fax:513-541-0989
Practice Address - Street 1:3021 VERNON PL
Practice Address - Street 2:SUTIE 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2417
Practice Address - Country:US
Practice Address - Phone:513-541-7099
Practice Address - Fax:513-541-0989
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110515101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)