NPIMap

Individual provider Active NPI

Jessica Fairbank

  • Addiction (Substance Use Disorder) Counselor
  • Hamilton, OH
National Provider Identifier
1881298818
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CDCA174793
Practice address
3103 Dixie Hwy
Hamilton, OH 45015-1653
Phone
(513) 892-4673
Fax
(512) 737-1107
NPI assigned
Nov 30, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA174793 Primary

Addresses

Primary practice location

3103 Dixie Hwy
Hamilton, OH 45015-1653

Mailing address

3103 Dixie Hwy
Hamilton, OH 45015-1653
Phone (513) 892-4673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Decoach Team LLC CurrentSince Jan 21, 2022 Accepting new patients
Decoach Team LLC CurrentSince Jan 21, 2022 Accepting new patients
Airrosti Buckeye, Inc. PastSince Dec 1, 2020 Accepting new patients
Pinnacle Treatment Centers Oh-Xiii, LLC PastSince Dec 1, 2020 Accepting new patients

Locations

3103 Dixie Hwy
Hamilton, OH 45015
Phone (513) 892-4673

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642118400000",
    "number": "1881298818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 DIXIE HWY",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450151653",
            "telephone_number": "513-892-4673",
            "fax_number": "513-737-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 DIXIE HWY",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450151653",
            "telephone_number": "513-892-4673",
            "fax_number": "512-737-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANK",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-30",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": "CDCA174793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.