Healthcare Provider Details

I. General information

NPI: 1588425508
Provider Name (Legal Business Name): LAURA L. DEKLE, LPCC-S, LICDC-CS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 OLD HENDERSON RD STE 207
COLUMBUS OH
43220-3623
US

IV. Provider business mailing address

1170 OLD HENDERSON RD STE 207
COLUMBUS OH
43220-3623
US

V. Phone/Fax

Practice location:
  • Phone: 614-348-8774
  • Fax: 614-846-6521
Mailing address:
  • Phone: 614-348-8774
  • Fax: 614-846-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURA DEKLE
Title or Position: OWNER
Credential: LPCC-S, LICDC-CS
Phone: 614-348-8774