Healthcare Provider Details

I. General information

NPI: 1922179852
Provider Name (Legal Business Name): KATHLEEN L STEIN LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 E BROAD ST SUITE 100
COLUMBUS OH
43205-1156
US

IV. Provider business mailing address

899 E BROAD ST SUITE 100
COLUMBUS OH
43205-1156
US

V. Phone/Fax

Practice location:
  • Phone: 614-220-8655
  • Fax: 614-267-7013
Mailing address:
  • Phone: 614-220-8655
  • Fax: 614-267-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberI 1500454 SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI 1500454 SUPV
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI 1500454 SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: