Provider Demographics
NPI:1396235578
Name:FARMER, WAYMAN (CDCA)
Entity type:Individual
Prefix:MR
First Name:WAYMAN
Middle Name:
Last Name:FARMER
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 1:5734 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2072
Mailing Address - Country:US
Mailing Address - Phone:419-724-1500
Mailing Address - Fax:419-724-1616
Practice Address - Street 1:5734 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2072
Practice Address - Country:US
Practice Address - Phone:419-724-1500
Practice Address - Fax:419-724-1616
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190241101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)