Healthcare Provider Details

I. General information

NPI: 1720995996
Provider Name (Legal Business Name): RAJESH BANSAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7058 CORPORATE WAY STE 3
DAYTON OH
45459-4243
US

IV. Provider business mailing address

7058 CORPORATE WAY STE 3
DAYTON OH
45459-4243
US

V. Phone/Fax

Practice location:
  • Phone: 937-991-0080
  • Fax: 937-991-0083
Mailing address:
  • Phone: 937-991-0080
  • Fax: 937-991-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.196178
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: