Healthcare Provider Details

I. General information

NPI: 1952979106
Provider Name (Legal Business Name): KOSIS - KNOWLEDGE OF SELF IS SUPREME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N E ST
HAMILTON OH
45013-3048
US

IV. Provider business mailing address

222 N E ST
HAMILTON OH
45013-3048
US

V. Phone/Fax

Practice location:
  • Phone: 614-407-4590
  • Fax:
Mailing address:
  • Phone: 614-407-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MIKAEL L WHITE-DAVIS
Title or Position: CEO/CLINICAL DIRECTOR
Credential: LPCC
Phone: 513-591-9546