Provider Demographics
NPI:1184978702
Name:HALLAVELD, RITA D (LISW)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:D
Last Name:HALLAVELD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:SHOUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RITA MESSER
Mailing Address - Street 1:4624 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2247
Mailing Address - Country:US
Mailing Address - Phone:614-459-4490
Mailing Address - Fax:614-457-3656
Practice Address - Street 1:4624 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220
Practice Address - Country:US
Practice Address - Phone:614-459-4490
Practice Address - Fax:614-457-3656
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1000319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker