Organization
MARK MODLIN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ALAN MODLIN M.S., N.C.C. (OWNER)
(859) 341-7170
Entity
Organization
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
Other
Enumeration date
08/05/2014
Last updated
08/05/2014
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