Provider Demographics
NPI:1598083669
Name:GOREE DAVIES, KATHERINE HUNTER (LISW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:HUNTER
Last Name:GOREE DAVIES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:61 E TORRENCE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3819
Mailing Address - Country:US
Mailing Address - Phone:614-537-1470
Mailing Address - Fax:888-902-4030
Practice Address - Street 1:4701 OLENTANGY RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1950
Practice Address - Country:US
Practice Address - Phone:614-537-1470
Practice Address - Fax:888-902-4030
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10002721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW37511Medicare UPIN