Provider Demographics
NPI:1194231589
Name:GONELA, RAAKHEE BANSAL (PSYD, LICDC)
Entity type:Individual
Prefix:DR
First Name:RAAKHEE
Middle Name:BANSAL
Last Name:GONELA
Suffix:
Gender:F
Credentials:PSYD, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 BRICE RD STE A
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2796
Mailing Address - Country:US
Mailing Address - Phone:614-864-3434
Mailing Address - Fax:
Practice Address - Street 1:1649 BRICE RD STE A
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2796
Practice Address - Country:US
Practice Address - Phone:614-864-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHP.08674103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)