Provider Demographics
NPI:1194242792
Name:AYERS, DAPHNE CHRISTINE (LISW-S, LICDC-CS, GA)
Entity type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:CHRISTINE
Last Name:AYERS
Suffix:
Gender:F
Credentials:LISW-S, LICDC-CS, GA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 NORTHLAND DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3440
Mailing Address - Country:US
Mailing Address - Phone:330-764-3659
Mailing Address - Fax:330-764-8126
Practice Address - Street 1:246 NORTHLAND DR STE 200A
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3440
Practice Address - Country:US
Practice Address - Phone:330-764-3659
Practice Address - Fax:330-764-8126
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161376101YA0400X
OHS1700154104100000X
OH175T00000X
OHI.22041241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268032Medicaid