Healthcare Provider Details

I. General information

NPI: 1285461855
Provider Name (Legal Business Name): MARK KUHNS CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E STATE ST STE D
ATHENS OH
45701-1870
US

IV. Provider business mailing address

400 E STATE ST STE D
ATHENS OH
45701-1870
US

V. Phone/Fax

Practice location:
  • Phone: 937-367-2755
  • Fax:
Mailing address:
  • Phone: 937-367-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA189131
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: