Provider Demographics
NPI:1649498239
Name:WAUGH, KAREN SARITA (LISW, LICC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SARITA
Last Name:WAUGH
Suffix:
Gender:F
Credentials:LISW, LICC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 N. HIGH STREET,
Mailing Address - Street 2:SUITE 310
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3539
Mailing Address - Country:US
Mailing Address - Phone:614-262-4600
Mailing Address - Fax:614-262-4605
Practice Address - Street 1:3805 N. HIGH STREET,
Practice Address - Street 2:SUITE 310
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3539
Practice Address - Country:US
Practice Address - Phone:614-262-4600
Practice Address - Fax:614-262-4605
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH975897101YA0400X
OHI-00084481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWASW26541Medicare ID - Type Unspecified