Healthcare Provider Details

I. General information

NPI: 1033607379
Provider Name (Legal Business Name): KODI C HANEY LSW, LCDC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FAYETTE CTR
WASHINGTON COURT HOUSE OH
43160-2120
US

IV. Provider business mailing address

110 HIGHLAND AVE
CIRCLEVILLE OH
43113-1208
US

V. Phone/Fax

Practice location:
  • Phone: 740-335-8228
  • Fax:
Mailing address:
  • Phone: 740-477-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.161771
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1802141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: