Provider Demographics
NPI:1053807461
Name:RUSHING, KEVIN DOUGLAS (CDCA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DOUGLAS
Last Name:RUSHING
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 1:4808 AMESBURY RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2008
Mailing Address - Country:US
Mailing Address - Phone:419-461-2165
Mailing Address - Fax:
Practice Address - Street 1:4808 AMESBURY RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2008
Practice Address - Country:US
Practice Address - Phone:419-461-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.090590101YA0400X
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator