Provider Demographics
NPI:1124743539
Name:LAROCHE, LISA DANIELLE (CDCA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DANIELLE
Last Name:LAROCHE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 GEORGESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-2420
Mailing Address - Country:US
Mailing Address - Phone:614-252-4941
Mailing Address - Fax:855-908-2509
Practice Address - Street 1:491 GEORGESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-2420
Practice Address - Country:US
Practice Address - Phone:614-252-4941
Practice Address - Fax:855-908-2509
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHCDCA.185224101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator