Provider Demographics
NPI:1659865053
Name:RAYBURN, ANGELA CHRISTINA (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHRISTINA
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6107
Mailing Address - Country:US
Mailing Address - Phone:513-242-7600
Mailing Address - Fax:
Practice Address - Street 1:4721 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6107
Practice Address - Country:US
Practice Address - Phone:513-242-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801276101YM0800X
ORC.1801276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.1801276Medicaid