Provider Demographics
NPI:1760784334
Name:MCCONNELL, GINA A (LPCC-S)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:A
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10597 MONTGOMERY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4471
Mailing Address - Country:US
Mailing Address - Phone:513-793-6226
Mailing Address - Fax:513-793-5054
Practice Address - Street 1:10597 MONTGOMERY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4471
Practice Address - Country:US
Practice Address - Phone:513-793-6226
Practice Address - Fax:513-793-5054
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991570101YA0400X
OHE0003282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)