Healthcare Provider Details

I. General information

NPI: 1821636895
Provider Name (Legal Business Name): RACHELLE ANN WISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHELLE ANN VARGO

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 HARRISON AVE
CINCINNATI OH
45247-7957
US

IV. Provider business mailing address

6460 HARRISON AVE STE 200
CINCINNATI OH
45247-7958
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-4999
  • Fax: 513-694-0168
Mailing address:
  • Phone: 513-941-4999
  • Fax: 513-694-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.168519
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.172347
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: