Provider Demographics
NPI:1013125954
Name:KINNE, BRIAN TIMOTHY (CADC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:KINNE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8361 ASHHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-3774
Mailing Address - Country:US
Mailing Address - Phone:513-347-9581
Mailing Address - Fax:
Practice Address - Street 1:3629 CHURCH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1430
Practice Address - Country:US
Practice Address - Phone:859-581-8974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)