Healthcare Provider Details

I. General information

NPI: 1427678374
Provider Name (Legal Business Name): SUSAN GRGAS LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 SKYVIEW CIR
CINCINNATI OH
45248-1933
US

IV. Provider business mailing address

8977 COLUMBIA RD STE A
LOVELAND OH
45140-1100
US

V. Phone/Fax

Practice location:
  • Phone: 513-325-5535
  • Fax:
Mailing address:
  • Phone: 513-409-3635
  • Fax: 513-826-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberI.1801334
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.1801334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: