Provider Demographics
NPI:1073341640
Name:HILL, KURT (CDCA)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 MOUNT VERNON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5265
Mailing Address - Country:US
Mailing Address - Phone:740-341-2067
Mailing Address - Fax:
Practice Address - Street 1:245 SAINT JAMES ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5134
Practice Address - Country:US
Practice Address - Phone:740-341-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.189137101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)