Healthcare Provider Details

I. General information

NPI: 1912593492
Provider Name (Legal Business Name): SONDRA GAYHART CDCA.179666
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N 4TH ST
IRONTON OH
45638-1403
US

IV. Provider business mailing address

117 N 4TH ST
IRONTON OH
45638-1403
US

V. Phone/Fax

Practice location:
  • Phone: 740-237-4981
  • Fax: 740-879-0599
Mailing address:
  • Phone: 740-237-4981
  • Fax: 740-879-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA179666
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.175293
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA179666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: