Provider Demographics
NPI:1508423757
Name:HANES-TABLER, CAYLA MARIE (CDCA)
Entity Type:Individual
Prefix:
First Name:CAYLA
Middle Name:MARIE
Last Name:HANES-TABLER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 KARI LN
Mailing Address - Street 2:
Mailing Address - City:BYESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43723-9715
Mailing Address - Country:US
Mailing Address - Phone:740-255-3112
Mailing Address - Fax:740-439-1031
Practice Address - Street 1:927 WHEELING AVE STE 310
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2340
Practice Address - Country:US
Practice Address - Phone:740-439-4532
Practice Address - Fax:740-439-1031
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170325101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)