Provider Demographics
NPI:1548564669
Name:WOOTON, LENA RAE (MED, LPCC-S)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:RAE
Last Name:WOOTON
Suffix:
Gender:F
Credentials:MED, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 CHILLICOTHE ST STE M111
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4079
Mailing Address - Country:US
Mailing Address - Phone:941-445-0462
Mailing Address - Fax:
Practice Address - Street 1:602 CHILLICOTHE ST STE M111
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4079
Practice Address - Country:US
Practice Address - Phone:941-445-0462
Practice Address - Fax:941-445-0462
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHE.1700434-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH070980800Medicaid
FL070980800Medicaid