Healthcare Provider Details

I. General information

NPI: 1841775384
Provider Name (Legal Business Name): KIM CASSANDRA HEFLIN CDCA LLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM CASSANDRA HEFLIN CDCA LLL

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WAYNE AVE
DAYTON OH
45410-1122
US

IV. Provider business mailing address

1 ELIZABETH PL STE 1170
DAYTON OH
45417-3445
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number141607
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: