Individual
KELLY EADES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
302 W MAIN ST, FAIRBORN, OH 45324-5037
(937) 281-4673
(937) 318-1120
Mailing address
100 CROWNE POINT PL, CINCINNATI, OH 45241-5427
(513) 743-7628
(513) 737-1107
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCDCII.162034
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.181467
OH
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/18/2022
Last updated
08/21/2024
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