Doctor Name: | ROBERT THORNTON IRWIN |
NPI Number: | 1154734697 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.I.C.D.C. |
License Number: | 121104 |
Business Practice Address: | 68518 Bannock Rd P.o. 540 Saint Clairsville, OH - 439509736 |
Business Phone Number: | 7406955169 |
Business Fax Number: | |
Mailing Address: | 68518 Bannock Rd, P.o. 540 SAINT CLAIRSVILLE |
State: | OH |
Postal Code: | 439509736 |
Phone Number: | 7406955169 |
Fax Number: | |
NPI Enumeration Date: | 06/03/2014 |
NPI Last Update Date: | 06/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 121104 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |