Healthcare Provider Details

I. General information

NPI: 1710615117
Provider Name (Legal Business Name): DONNA R WAFORD LICDC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 66TH ST
CINCINNATI OH
45216-1949
US

IV. Provider business mailing address

1612 CHASE AVE
CINCINNATI OH
45223-2204
US

V. Phone/Fax

Practice location:
  • Phone: 513-461-2158
  • Fax:
Mailing address:
  • Phone: 513-541-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number923364
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0022964
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: