Provider Demographics
NPI:1144727173
Name:CLINE, ROBERT K (CADC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:CLINE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 KENNISON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2726
Mailing Address - Country:US
Mailing Address - Phone:502-541-5984
Mailing Address - Fax:
Practice Address - Street 1:1020 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2630
Practice Address - Country:US
Practice Address - Phone:502-585-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY119441101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY119441OtherBOARD OF ALCOHOL AND DRUG COUNSELORS