Provider Demographics
NPI:1184132300
Name:PURDY, RACHAEL GARDNER (LPC, LICDC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:GARDNER
Last Name:PURDY
Suffix:
Gender:F
Credentials:LPC, LICDC
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:207 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4307
Mailing Address - Country:US
Mailing Address - Phone:740-277-6043
Mailing Address - Fax:740-808-8027
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5369
Practice Address - Country:US
Practice Address - Phone:740-438-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700569101Y00000X
OHS.0029691104100000X
OHLICDC.161772101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker