Healthcare Provider Details

I. General information

NPI: 1235961202
Provider Name (Legal Business Name): GINA JOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 LAFAYETTE ST STE E
LONDON OH
43140-8567
US

IV. Provider business mailing address

231 LAFAYETTE ST STE E
LONDON OH
43140-8567
US

V. Phone/Fax

Practice location:
  • Phone: 740-901-0844
  • Fax:
Mailing address:
  • Phone: 740-901-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193303
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: