Provider Demographics
NPI:1750704995
Name:RIGG, KEVIN E (PCC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:RIGG
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-1835
Mailing Address - Country:US
Mailing Address - Phone:419-226-9171
Mailing Address - Fax:419-996-5432
Practice Address - Street 1:1875 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1835
Practice Address - Country:US
Practice Address - Phone:419-226-9171
Practice Address - Fax:419-996-5432
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081173101YA0400X
OHE0005753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)