Provider Demographics
NPI:1558889782
Name:THE GAP INITIATIVE
Entity Type:Organization
Organization Name:THE GAP INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:I
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:614-586-3830
Mailing Address - Street 1:6596 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9394
Mailing Address - Country:US
Mailing Address - Phone:614-327-0535
Mailing Address - Fax:
Practice Address - Street 1:1611 OLD LEONARD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2597
Practice Address - Country:US
Practice Address - Phone:614-327-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty