Provider Demographics
NPI:1730895269
Name:MCGRUDER, DORIAN ANTONIO (CDCA)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:ANTONIO
Last Name:MCGRUDER
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 1:3515 SIARON WAY LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2684
Mailing Address - Country:US
Mailing Address - Phone:513-795-6972
Mailing Address - Fax:513-902-8765
Practice Address - Street 1:3515 SIARON WAY LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2684
Practice Address - Country:US
Practice Address - Phone:513-795-6972
Practice Address - Fax:513-902-8765
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.183106101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)