Provider Demographics
NPI:1407372360
Name:DAVIDSON, KELSEY (LICDC, LPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LICDC, LPC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:BRONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 PROGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2942
Mailing Address - Country:US
Mailing Address - Phone:513-704-3391
Mailing Address - Fax:
Practice Address - Street 1:800 COMPTON RD UNIT 12
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3846
Practice Address - Country:US
Practice Address - Phone:859-746-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHLICDC.162318101YA0400X
OHC.2304830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)