Provider Demographics
NPI:1205309101
Name:CANTRELL, KITANA M (LPC)
Entity type:Individual
Prefix:
First Name:KITANA
Middle Name:M
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 TONG HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:45612-1500
Mailing Address - Country:US
Mailing Address - Phone:740-313-0571
Mailing Address - Fax:
Practice Address - Street 1:25773 STATE ROUTE 41
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-8953
Practice Address - Country:US
Practice Address - Phone:740-357-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103396101Y00000X
OHW.1800144104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker