Healthcare Provider Details

I. General information

NPI: 1023549391
Provider Name (Legal Business Name): CENTRAL CLINIC OUTPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 ALBERT SABIN WAY
CINCINNATI OH
45229-2838
US

IV. Provider business mailing address

311 ALBERT SABIN WAY
CINCINNATI OH
45229-2838
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-9005
  • Fax: 513-558-3880
Mailing address:
  • Phone: 513-558-9005
  • Fax: 513-558-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY G MAGES
Title or Position: PRESIDENT/CEO
Credential: PH.D., LPCC
Phone: 513-558-5879