Healthcare Provider Details

I. General information

NPI: 1548816366
Provider Name (Legal Business Name): JOSEPH W VITALES LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 HARMON AVE
COLUMBUS OH
43223
US

IV. Provider business mailing address

11361 N 99TH AVE STE 402
PEORIA AZ
85345-5459
US

V. Phone/Fax

Practice location:
  • Phone: 614-222-3737
  • Fax: 614-358-4201
Mailing address:
  • Phone: 602-650-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162727
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411457
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: