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General NPI Number Information
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NPI Number | 1598114803
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Entity Type | Individual
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Provider Name | KAMILAH MATHIEU
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Gender | Female
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 5108 SANDY LN
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City | FAIRFIELD
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State | OH
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Zip | 45014-2738
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Country | US
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Telephone | 866-934-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 MONTOGMERY RD SUITE 400
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City | CINCINNATI
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State | OH
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Zip | 45212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1601004
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.161407
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.150697-PRE
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License Number State | OH
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