Provider Demographics
NPI:1710615117
Name:WAFORD, DONNA R (LICDC, LSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:WAFORD
Suffix:
Gender:F
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-2204
Mailing Address - Country:US
Mailing Address - Phone:513-541-7111
Mailing Address - Fax:
Practice Address - Street 1:109 W 66TH ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1949
Practice Address - Country:US
Practice Address - Phone:513-461-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0022964104100000X
OH923364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty