Healthcare Provider Details

I. General information

NPI: 1275509143
Provider Name (Legal Business Name): ALCOHOL AND DRUG FREEDOM CENTER OF KNOX COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E GAMBIER ST
MOUNT VERNON OH
43050-3510
US

IV. Provider business mailing address

106 E GAMBIER ST
MOUNT VERNON OH
43050-3510
US

V. Phone/Fax

Practice location:
  • Phone: 740-397-2660
  • Fax: 740-392-3613
Mailing address:
  • Phone: 740-397-2660
  • Fax: 740-392-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1311
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number01-7560
License Number StateOH

VIII. Authorized Official

Name: DR. AFET KILINC
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D., LPCC-S
Phone: 740-397-2660