Provider Demographics
NPI:1679850887
Name:GOHSMAN, KIRK DONALD (ICADC, CRADC)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:DONALD
Last Name:GOHSMAN
Suffix:
Gender:M
Credentials:ICADC, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S. COUNTRY FAIR DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821
Mailing Address - Country:US
Mailing Address - Phone:217-373-8200
Mailing Address - Fax:
Practice Address - Street 1:106 S. COUNTRY FAIR DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821
Practice Address - Country:US
Practice Address - Phone:217-373-8200
Practice Address - Fax:217-373-5233
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30872101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)