Healthcare Provider Details

I. General information

NPI: 1518754266
Provider Name (Legal Business Name): KACY GAINOR CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 GLENDON CT
DUBLIN OH
43016-3246
US

IV. Provider business mailing address

5500 GLENDON CT
DUBLIN OH
43016-3246
US

V. Phone/Fax

Practice location:
  • Phone: 501-426-3086
  • Fax: 614-468-2820
Mailing address:
  • Phone: 501-426-3086
  • Fax: 614-468-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number1175614
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: