Provider Demographics
NPI:1013215565
Name:METZGER, KAOLENE ANN (PCC-S, NCC)
Entity Type:Individual
Prefix:
First Name:KAOLENE
Middle Name:ANN
Last Name:METZGER
Suffix:
Gender:F
Credentials:PCC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8666 EASTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8733
Mailing Address - Country:US
Mailing Address - Phone:330-904-5103
Mailing Address - Fax:
Practice Address - Street 1:8666 EASTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-8733
Practice Address - Country:US
Practice Address - Phone:330-904-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0700271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional