Provider Demographics
NPI:1982951190
Name:UBA, LIVINUS C (ICADC, LCDCIII, CADC)
Entity Type:Individual
Prefix:
First Name:LIVINUS
Middle Name:C
Last Name:UBA
Suffix:
Gender:M
Credentials:ICADC, LCDCIII, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2065
Mailing Address - Country:US
Mailing Address - Phone:606-393-4632
Mailing Address - Fax:888-411-4131
Practice Address - Street 1:3655 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2065
Practice Address - Country:US
Practice Address - Phone:606-393-4632
Practice Address - Fax:888-411-4131
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121019101YA0400X
ZZ710053101YA0400X
ZZ128644101YA0400X
KY166426101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)