Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 1041C0700X | Clinical Social Worker | S.1802558 | OH |
NPI | 1003450511 |
---|---|
Provider Name | Moffou Katherine Tchoula |
First Address | Columbus, OH 43213-2950 |
Second Address | Columbus, OH 43213-2950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 12/11/2019 |