Healthcare Provider Details

I. General information

NPI: 1326228735
Provider Name (Legal Business Name): FAITH RENEE CARGILE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SUMMIT RD
CINCINNATI OH
45237-2621
US

IV. Provider business mailing address

1101 SUMMIT RD
CINCINNATI OH
45237-2621
US

V. Phone/Fax

Practice location:
  • Phone: 513-948-3749
  • Fax: 513-948-8631
Mailing address:
  • Phone: 513-948-3749
  • Fax: 513-948-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number964563
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0008299
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: