Healthcare Provider Details

I. General information

NPI: 1578928503
Provider Name (Legal Business Name): RAQUEL TOBIAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

V. Phone/Fax

Practice location:
  • Phone: 614-388-7231
  • Fax: 614-257-5418
Mailing address:
  • Phone: 614-388-7231
  • Fax: 614-257-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161331
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1600908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: