Healthcare Provider Details

I. General information

NPI: 1154182566
Provider Name (Legal Business Name): CHASITY M CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9145 GOVERNORS WAY
CINCINNATI OH
45249-2037
US

IV. Provider business mailing address

9145 GOVERNORS WAY
CINCINNATI OH
45249-2037
US

V. Phone/Fax

Practice location:
  • Phone: 513-637-3571
  • Fax:
Mailing address:
  • Phone: 513-637-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCDCA.183503
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.187245
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162961
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: