Provider Demographics
NPI:1942735584
Name:BOTTS, BARBARA ELLE (LCDC III)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELLE
Last Name:BOTTS
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5537
Mailing Address - Country:US
Mailing Address - Phone:614-398-3470
Mailing Address - Fax:614-340-3083
Practice Address - Street 1:360 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5537
Practice Address - Country:US
Practice Address - Phone:614-398-3470
Practice Address - Fax:614-340-3083
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161398101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)