Healthcare Provider Details

I. General information

NPI: 1245824879
Provider Name (Legal Business Name): KATHERINE VINION CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N CANFIELD NILES RD
YOUNGSTOWN OH
44515-2343
US

IV. Provider business mailing address

45 N CANFIELD NILES RD
AUSTINTOWN OH
44515-2343
US

V. Phone/Fax

Practice location:
  • Phone: 330-642-8242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberCDCA.176014
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.180622
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: