Individual provider Active NPI

Douglas Wilson, CDCA

  • Addiction (Substance Use Disorder) Counselor
  • Lima, OH
National Provider Identifier
1427633411
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CDCA.184786 Issued in OH
Practice address
1505 N Cole St
Lima, OH 45801-2432
Phone
(833) 510-4357
Fax
(866) 460-2997
NPI assigned
Mar 11, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X APS.002194 OH
Case Manager/Care Coordinator 171M00000X 180516 OH
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA.184786 OH Primary

Addresses

Primary practice location

1505 N Cole St
Lima, OH 45801-2432

Mailing address

4600 Montgomery Rd Ste 400
Cincinnati, OH 45212-2600

Other identifiers 1

IdentifierTypeStateIssuer
0315095MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CDCA.184786OHMDAddiction (Substance Use Disorder) Counselor
180516OHMDCase Manager/Care Coordinator
APS.002194OHMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Lima-Urban Minority Alcoholism and Drug Abuse Outreach Program., Inc CurrentSince Jan 1, 2023 Accepting new patients
Lima-Urban Minority Alcoholism and Drug Abuse Outreach Program., Inc CurrentSince Jan 1, 2023 Accepting new patients

Locations

311 E Market St
Fl 3
Lima, OH 45801
Phone (419) 222-4474

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777852800000",
    "number": "1427633411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MONTGOMERY RD STE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 N COLE ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458012432",
            "telephone_number": "833-510-4357",
            "fax_number": "866-460-2997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DOUGLAS",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-11",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "APS.002194",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OH",
            "license": "180516",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.184786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0315095",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lima, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2026; 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.