Provider Demographics
NPI:1679282321
Name:WIREBAUGH, MICAH DANIEL (CDCA)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:DANIEL
Last Name:WIREBAUGH
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:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-0722
Mailing Address - Country:US
Mailing Address - Phone:419-562-2400
Mailing Address - Fax:419-617-3771
Practice Address - Street 1:114 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2324
Practice Address - Country:US
Practice Address - Phone:419-562-2400
Practice Address - Fax:419-617-3771
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)