Provider Demographics
NPI:1922713569
Name:GUINN, WATHENIA ANN (CDCA)
Entity Type:Individual
Prefix:MRS
First Name:WATHENIA
Middle Name:ANN
Last Name:GUINN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 HIGHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:KY
Mailing Address - Zip Code:41016-1688
Mailing Address - Country:US
Mailing Address - Phone:513-276-2710
Mailing Address - Fax:
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-813-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.176492101YA0400X
OHCDCA.178263101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)