Healthcare Provider Details

I. General information

NPI: 1033230289
Provider Name (Legal Business Name): ENA INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PRIVATE DR. 997
PEDRO OH
45659
US

IV. Provider business mailing address

1404 RACE STREET SUITE 302
CINCINNATI OH
45202
US

V. Phone/Fax

Practice location:
  • Phone: 740-534-1386
  • Fax: 740-534-1497
Mailing address:
  • Phone: 513-381-1531
  • Fax: 859-276-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK DAVIS
Title or Position: CFO
Credential:
Phone: 513-381-1531