Healthcare Provider Details

I. General information

NPI: 1487010633
Provider Name (Legal Business Name): MONICA CRIMMINS LICDC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 07/21/2022
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 N MAIN
MARION OH
43302
US

IV. Provider business mailing address

615 ELSINORE PL STE 200
CINCINNATI OH
45202-1459
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax: 513-873-1567
Mailing address:
  • Phone: 513-834-7063
  • Fax: 513-873-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161483
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: