Provider Demographics
NPI:1952819997
Name:LINCKS, SUSAN AMBER (CDCA, LPN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:AMBER
Last Name:LINCKS
Suffix:
Gender:F
Credentials:CDCA, LPN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:AMBER
Other - Last Name:LINCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:809 WATERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8182
Mailing Address - Country:US
Mailing Address - Phone:513-475-0784
Mailing Address - Fax:
Practice Address - Street 1:809 WATERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8182
Practice Address - Country:US
Practice Address - Phone:513-478-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.138775.MEDS.IV164W00000X, 164W00000X
OHCDCA.186682101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse