Individual
MARK ALAN MODLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
130 DUDLEY PIKE, SUITE 120, EDGEWOOD, KY 41017-2396
(859) 341-7170
(859) 341-7173
Mailing address
130 DUDLEY PIKE, SUITE 120, EDGEWOOD, KY 41017-2396
(859) 341-7170
(859) 341-7173
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C.0001640
OH
101Y00000X
Counselor
Primary
KY-0206
KY
101YA0400X
Addiction (Substance Use Disorder) Counselor
C.0001640
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
KY-0206
KY
101YM0800X
Mental Health Counselor
C.0001640
OH
101YM0800X
Mental Health Counselor
KY-0206
KY
101YP2500X
Professional Counselor
C.0001640
OH
101YP2500X
Professional Counselor
KY-0206
KY
Other
Enumeration date
03/28/2014
Last updated
07/29/2014
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