Provider Demographics
NPI:1538656426
Name:REED, AUTUMN (BS, CDCA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:BS, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 KENNYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2606
Mailing Address - Country:US
Mailing Address - Phone:513-267-4374
Mailing Address - Fax:
Practice Address - Street 1:777 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1684
Practice Address - Country:US
Practice Address - Phone:513-228-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHCDCA.164759101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)