Provider Demographics
NPI:1245596527
Name:OVERTON, KIERRA M (LSW)
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:M
Last Name:OVERTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 WATERMARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7088
Mailing Address - Country:US
Mailing Address - Phone:614-487-8758
Mailing Address - Fax:614-227-9447
Practice Address - Street 1:5500 S MARGINAL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1072
Practice Address - Country:US
Practice Address - Phone:614-487-8758
Practice Address - Fax:614-227-9447
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1200318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker