Provider Demographics
NPI:1831159383
Name:GARDNER, BARBARA ANNE (LPCC LICDC)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANNE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LPCC LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 NORTHLAND DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1533
Mailing Address - Country:US
Mailing Address - Phone:330-723-9600
Mailing Address - Fax:330-722-1446
Practice Address - Street 1:246 NORTHLAND DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1533
Practice Address - Country:US
Practice Address - Phone:330-723-9600
Practice Address - Fax:330-722-1446
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH872391101YA0400X
OHE4104101YP2500X
OHS12751104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker