Provider Demographics
NPI:1871011056
Name:HARGRAVE, DAVID CHRISTOPHER (LSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:HARGRAVE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE VILLAGE NETWORK 2000 NOBLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2311
Mailing Address - Country:US
Mailing Address - Phone:330-202-3976
Mailing Address - Fax:330-202-3894
Practice Address - Street 1:THE VILLAGE NETWORK 2000 NOBLE DRIVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2311
Practice Address - Country:US
Practice Address - Phone:330-202-3976
Practice Address - Fax:330-202-3894
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1502351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847147Medicaid
OHH233270OtherMEDICARE
OH1093103988OtherAOF
OH1124057914OtherBEHAVIORAL HEALTH