Healthcare Provider Details

I. General information

NPI: 1225771025
Provider Name (Legal Business Name): ALLISON ELIZABETH KEATING CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

IV. Provider business mailing address

2746 ENSLIN ST
CINCINNATI OH
45225-2312
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-6672
  • Fax:
Mailing address:
  • Phone: 513-781-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number174936
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: