Healthcare Provider Details

I. General information

NPI: 1639431042
Provider Name (Legal Business Name): HEALTH RESOURCE CENTER OF CINCINNATI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 VINE STREET
CINCINNATI OH
45219-1745
US

IV. Provider business mailing address

2347 VINE STREET
CINCINNATI OH
45219-1745
US

V. Phone/Fax

Practice location:
  • Phone: 513-357-4602
  • Fax: 513-621-2350
Mailing address:
  • Phone: 513-357-4602
  • Fax: 513-621-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. CORNELIA RONAN WILSON
Title or Position: PRESIDENT AND CEO
Credential: EDD, LPCC, PMHCNS-BC
Phone: 513-357-4602