Healthcare Provider Details

I. General information

NPI: 1609234715
Provider Name (Legal Business Name): CATHERINE SHORT LSW, LCDC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E STATE ST STE D
ATHENS OH
45701-1870
US

IV. Provider business mailing address

1036 FAY AVE
LANCASTER OH
43130-1003
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number161034
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1500163
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: