Healthcare Provider Details

I. General information

NPI: 1336801372
Provider Name (Legal Business Name): ELISABETH KAY VENABLES LBSW, LCDC III, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISABETH VENABLES

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W. MARKET ST.
GEORGETOWN DE
19947
US

IV. Provider business mailing address

615 ELSINORE PL STE 200
CINCINNATI OH
45202-1457
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax:
Mailing address:
  • Phone: 513-834-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162218
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberQ4-0000080
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: