Healthcare Provider Details

I. General information

NPI: 1013125954
Provider Name (Legal Business Name): BRIAN TIMOTHY KINNE CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 CHURCH ST
COVINGTON KY
41015-1430
US

IV. Provider business mailing address

8361 ASHHOLLOW DR
CINCINNATI OH
45247-3774
US

V. Phone/Fax

Practice location:
  • Phone: 859-581-8974
  • Fax:
Mailing address:
  • Phone: 513-347-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0933
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: