Healthcare Provider Details

I. General information

NPI: 1407771066
Provider Name (Legal Business Name): GEMINI SHORES COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8977 COLUMBIA RD STE G
LOVELAND OH
45140-1100
US

IV. Provider business mailing address

8903 PEMBROOKE ST
MAINEVILLE OH
45039-9742
US

V. Phone/Fax

Practice location:
  • Phone: 513-404-4159
  • Fax:
Mailing address:
  • Phone: 513-404-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. KERRI D MCKENNA
Title or Position: CLINICAL SOCIAL WORKER
Credential: ED.D., MSW, LISW
Phone: 513-404-4159