Provider Demographics
NPI:1750791026
Name:VANDERPOOL, CATHY JO (PC, LICDC)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:JO
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:PC, LICDC
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:JO
Other - Last Name:VERONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PC, LICDC
Mailing Address - Street 1:4428 STATE ROUTE 222
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-9777
Mailing Address - Country:US
Mailing Address - Phone:513-685-5018
Mailing Address - Fax:513-732-8000
Practice Address - Street 1:4428 STATE ROUTE 222
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-9777
Practice Address - Country:US
Practice Address - Phone:513-685-5018
Practice Address - Fax:513-732-8000
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH975943101YA0400X
OHC 0002757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)