Healthcare Provider Details

I. General information

NPI: 1245887124
Provider Name (Legal Business Name): CHRISTINA MARIE MONTGOMERY-EVANS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2019
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CHEVIOT RD
CINCINNATI OH
45247-7003
US

IV. Provider business mailing address

437 SAMOHT RIDGE RD
CINCINNATI OH
45238-5531
US

V. Phone/Fax

Practice location:
  • Phone: 513-740-1001
  • Fax:
Mailing address:
  • Phone: 716-327-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.175434
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: