Provider Demographics
NPI:1295551265
Name:PEYTOH, CHARONNE
Entity type:Individual
Prefix:
First Name:CHARONNE
Middle Name:
Last Name:PEYTOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2377
Mailing Address - Country:US
Mailing Address - Phone:614-381-7482
Mailing Address - Fax:
Practice Address - Street 1:876 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2377
Practice Address - Country:US
Practice Address - Phone:614-381-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2403966-TRNE1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool