MEDICARE: ALCOHOL AND DRUG FREEDOM CENTER OF KNOX COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1311	OH
2	251S00000X	Community/Behavioral Health Agency	01-7560	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35842	OTHER	OH	MBC (MERIT/BIODYNE)
2	3908853	OTHER	OH	FDA ID#
3	45660	OTHER	OH	ODADAS AGENCY NUMBER
4	62-15262	OTHER	OH	PHP/UBS NUMBER
5	729264	OTHER	OH	BWC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	62-15262	OTHER	OH	UHC OR UBH NUMBER
8	LICKBO131199	OTHER	OH	PSEUDO UCI
9	OH750732-00	OTHER	OH	NFR ID

General Provider Information

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

Provider Business Mailing Address
First Line	:	106 E GAMBIER ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-3510
Country	:	US
Telephone Number	:	740-397-2660
Fax Number	:	740-392-3613

Provider Business Practice Location Address
First Line	:	106 E GAMBIER ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-3510
Country	:	US
Telephone Number	:	740-397-2660
Fax Number	:	740-392-3613

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	01/24/2025

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