Basic Information
| Provider Information | |||||||||
| NPI: | 1376796722 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALHOUN | ||||||||
| FirstName: | BERNICE | ||||||||
| MiddleName: | RAEANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW, ACADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WILLIAM HOWARD TAFT RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133519900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1955 DIXIE HWY STE D | ||||||||
| Address2: | |||||||||
| City: | FT WRIGHT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593415757 | ||||||||
| FaxNumber: | 8593314757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2008 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCADC240049 | KY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | I.1901561 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW30635 | ID | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW252850 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.