Healthcare Provider Details

I. General information

NPI: 1801471875
Provider Name (Legal Business Name): DIANA BROWN CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 VERNON PL
CINCINNATI OH
45219-2414
US

IV. Provider business mailing address

110 KENNEDY RD
COVINGTON KY
41011-3647
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-7880
  • Fax:
Mailing address:
  • Phone: 513-281-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC.2103064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: