Provider Demographics
NPI:1508378068
Name:REARICK, DAVID BLAKE (LISW-SUPV)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BLAKE
Last Name:REARICK
Suffix:
Gender:M
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E DUBLIN GRANVILLE RD STE G
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3183
Mailing Address - Country:US
Mailing Address - Phone:614-436-7837
Mailing Address - Fax:614-436-8704
Practice Address - Street 1:445 E DUBLIN GRANVILLE RD STE G
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3183
Practice Address - Country:US
Practice Address - Phone:614-436-7837
Practice Address - Fax:614-436-8704
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007776104100000X
OH0007776-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker