Provider Demographics
NPI:1225102940
Name:WARNE, DOUG (MSW, LISW-S, LICDC)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:WARNE
Suffix:
Gender:M
Credentials:MSW, LISW-S, LICDC
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:D
Other - Last Name:WARNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NSW, LISW-S, LICDC
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-785-6523
Mailing Address - Fax:
Practice Address - Street 1:1441 PHALE D HALE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203
Practice Address - Country:US
Practice Address - Phone:614-785-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981021101YA0400X
OHDOT Q-SAP101Y00000X
OHI 00076731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311098079OtherTIN