Healthcare Provider Details

I. General information

NPI: 1619376936
Provider Name (Legal Business Name): OHIO TREATMENT AND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 SYMMES RD STE D
HAMILTON OH
45015-1383
US

IV. Provider business mailing address

3041 SYMMES RD STE D
HAMILTON OH
45015-1383
US

V. Phone/Fax

Practice location:
  • Phone: 513-860-9888
  • Fax: 513-860-2268
Mailing address:
  • Phone: 513-860-9888
  • Fax: 513-860-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. PRABODH VAIDYA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 312-399-8243