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General NPI Number Information
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NPI Number | 1700305430
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Entity Type | Organization
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Legal Business Name | CAPITAL BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 901 ROBINWOOD AVE STE B
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City | WHITEHALL
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State | OH
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Zip | 43213-1781
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Country | US
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Telephone | 614-425-2909
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Fax |
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Provider Business Mailing Address
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Address Line | 901 ROBINWOOD AVE STE B
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City | WHITEHALL
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State | OH
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Zip | 43213-1781
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Country | US
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Telephone | 614-425-2909
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | RAYSHAWN L WILSON
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Credential | LPCC
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Telephone | 614-425-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.1700277
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License Number State | OH
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