Provider Demographics
NPI:1831919505
Name:FUENTES, PATTI JO (CDCA)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:JO
Last Name:FUENTES
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDCA
Mailing Address - Street 1:7432 BASIL WESTERN RD NW
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9207
Mailing Address - Country:US
Mailing Address - Phone:380-799-6061
Mailing Address - Fax:614-396-9300
Practice Address - Street 1:5381 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1116
Practice Address - Country:US
Practice Address - Phone:380-799-6061
Practice Address - Fax:614-396-9300
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.189733101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)