Provider Demographics
NPI:1043613037
Name:KROTINE, MICHELLE (MA, LPC/CR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KROTINE
Suffix:
Gender:F
Credentials:MA, LPC/CR
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:KROTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2347 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2347 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1745
Practice Address - Country:US
Practice Address - Phone:513-621-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1100553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional