Healthcare Provider Details

I. General information

NPI: 1932740545
Provider Name (Legal Business Name): CHELSEA MARIE TRAYLOR LCDCII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S SOUTH ST
WILMINGTON OH
45177-2755
US

IV. Provider business mailing address

4790 SORG RD
HILLSBORO OH
45133-6749
US

V. Phone/Fax

Practice location:
  • Phone: 866-564-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone: 937-509-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCII.161707
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberQMHS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: