Provider Demographics
NPI:1538657556
Name:CIMA, THEA ANDREA (BS, TCADC)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:ANDREA
Last Name:CIMA
Suffix:
Gender:F
Credentials:BS, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 N KY 233
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:KY
Mailing Address - Zip Code:40734-6752
Mailing Address - Country:US
Mailing Address - Phone:606-521-2611
Mailing Address - Fax:
Practice Address - Street 1:3110 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8681
Practice Address - Country:US
Practice Address - Phone:606-523-9386
Practice Address - Fax:606-523-9307
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240587101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30613038Medicaid