Provider Demographics
NPI:1992843239
Name:KISSLING, AMY (CCDCI)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KISSLING
Suffix:
Gender:F
Credentials:CCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-0817
Mailing Address - Country:US
Mailing Address - Phone:937-599-1975
Mailing Address - Fax:937-599-2769
Practice Address - Street 1:118 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-599-1975
Practice Address - Fax:937-599-2769
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000991101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)