Healthcare Provider Details

I. General information

NPI: 1619205085
Provider Name (Legal Business Name): CAROL HETTEL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 CINCINNATI BATAVIA PIKE
CINCINNATI OH
45244-1518
US

IV. Provider business mailing address

555 CINCINNATI BATAVIA PIKE STE 5
CINCINNATI OH
45244-1556
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 513-752-1555
  • Fax: 513-753-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0700063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: