Joseph J Supina IV, CDCA, PRS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.190187 Issued in OH

Practice address

430 N Broadway St
Green Springs, OH 44836-9734

Phone

(844) 534-3638

NPI assigned

Sep 18, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sandusky Artisans Cooperative

  • Community/Behavioral Health Agency
  • Sandusky, OH
  • NPI 1467072025
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1023537446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 N BROADWAY ST",
            "city": "GREEN SPRINGS",
            "state": "OH",
            "postal_code": "448369734",
            "telephone_number": "844-534-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 N BROADWAY ST",
            "city": "GREEN SPRINGS",
            "state": "OH",
            "postal_code": "448369734",
            "telephone_number": "844-534-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPINA",
        "first_name": "JOSEPH",
        "middle_name": "J",
        "name_suffix": "IV",
        "credential": "CDCA, PRS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-18",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "APS.001751",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.190187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Michelle Runkle, RN
• Brent Shue
• Amiee Simmons, RN, BSN
• Spring Creek Nursing and Rehabilitation Center, LLC
• St. Francis Health Care Centre
• Dru Troyer
• Josh Levi Tyree, CDCA, PRS
• Kira Sue Van Der Laar, LISW
• Tiffani Amber Vollmar
• Adam Timothy Ward, LPN

• Addiction (Substance Use Disorder) Counselor in Green Springs, OH
• Providers in Green Springs, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.