Healthcare Provider Details

I. General information

NPI: 1578088134
Provider Name (Legal Business Name): AMY COMBS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S MARTIN LUTHER KING JR BLVD
HAMILTON OH
45011-3216
US

IV. Provider business mailing address

820 S MARTIN LUTHER KING JR BLVD
HAMILTON OH
45011-3216
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-5121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCDCA.150072
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: