Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Directly Affected

Organization Addiction (Substance Use Disorder) Counselor · NPI 1124603394

Directly Affected is an Addiction (Substance Use Disorder) Counselor in Mesa, Arizona. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
5
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Practice location Address checks out

2522 S Terripin
Mesa, AZ 85209-4959
Phone: (614) 980-2116
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adolescent and Children Mental Health Clinic/Center (primary) Taxonomy 261QM0855X
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X
Case Management Agency Taxonomy 251B00000X
Community/Behavioral Health Agency Taxonomy 251S00000X
Foster Care Agency Taxonomy 253J00000X

Record details

NPI number1124603394
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Dominique Myrick — President · (614) 980-2116
NPI enumeratedMarch 10, 2021
Last updated in NPPESMarch 10, 2021
Certification dateMarch 10, 2021
Mailing address2522 S Terripin, Mesa, AZ 85209-4959

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