Provider Demographics
NPI:1619406964
Name:MAYTON, GITI L (LISW)
Entity Type:Individual
Prefix:
First Name:GITI
Middle Name:L
Last Name:MAYTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 BROWN PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1165
Mailing Address - Country:US
Mailing Address - Phone:614-928-3663
Mailing Address - Fax:614-928-3664
Practice Address - Street 1:4384 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224
Practice Address - Country:US
Practice Address - Phone:614-556-4616
Practice Address - Fax:614-794-5155
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1700227104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker