Provider Demographics
NPI:1932553062
Name:VANCE, KAELA R (LPCC-S)
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:R
Last Name:VANCE
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 METRO PLACE NORTH
Mailing Address - Street 2:SUITE 100, OFFICE 108
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1389
Mailing Address - Country:US
Mailing Address - Phone:614-647-4357
Mailing Address - Fax:
Practice Address - Street 1:555 METRO PLACE NORTH
Practice Address - Street 2:SUITE 100, OFFICE 108
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1389
Practice Address - Country:US
Practice Address - Phone:614-647-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1200450-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid