Provider Demographics
NPI:1902347784
Name:HUNDLEY, JUSTINE (CDCA 2 SWA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:CDCA 2 SWA
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:NICOLE
Other - Last Name:PINKERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA 2 SWA
Mailing Address - Street 1:615 ELSINORE PL STE 300
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1475
Mailing Address - Country:US
Mailing Address - Phone:513-834-7063
Mailing Address - Fax:740-914-5005
Practice Address - Street 1:570 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:513-834-7063
Practice Address - Fax:513-873-1567
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHW.1800112104100000X
OHCDCA.163107101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker