Provider Demographics
NPI:1225539281
Name:SEYMORE, CELIA (CDCA)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:SEYMORE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 VICTORY PKWY # 45
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2859
Mailing Address - Country:US
Mailing Address - Phone:513-221-4500
Mailing Address - Fax:513-221-4700
Practice Address - Street 1:2368 VICTORY PKWY # 45
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2859
Practice Address - Country:US
Practice Address - Phone:513-319-3564
Practice Address - Fax:513-221-4700
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.090579101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid