Provider Demographics
NPI:1770943763
Name:RALL, DANETTE (PC)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:RALL
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 EAST DUBLIN GRANVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229
Mailing Address - Country:US
Mailing Address - Phone:614-267-7003
Mailing Address - Fax:614-267-7013
Practice Address - Street 1:1855 E DUBLIN GRANVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3516
Practice Address - Country:US
Practice Address - Phone:614-267-7003
Practice Address - Fax:614-267-7013
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1100393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional