Provider Demographics
NPI:1811395015
Name:WARE, ADRIANETTA K
Entity Type:Individual
Prefix:
First Name:ADRIANETTA
Middle Name:K
Last Name:WARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 WOOD LEAF LN
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5223
Mailing Address - Country:US
Mailing Address - Phone:614-357-3820
Mailing Address - Fax:
Practice Address - Street 1:2740 WOOD LEAF LN
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-5223
Practice Address - Country:US
Practice Address - Phone:614-357-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103K00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health