Healthcare Provider Details

I. General information

NPI: 1457712747
Provider Name (Legal Business Name): JESSICA RENEE TUBBS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7162 READING RD SUITE 500
CINCINNATI OH
45237-3838
US

IV. Provider business mailing address

7162 READING RD SUITE 500
CINCINNATI OH
45237-3838
US

V. Phone/Fax

Practice location:
  • Phone: 513-761-6222
  • Fax: 513-679-4590
Mailing address:
  • Phone: 513-761-6222
  • Fax: 513-679-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.131626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: