Provider Demographics
NPI:1346863602
Name:RABAH, KELLY (LISW-S, CPHQ, CPHRM)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RABAH
Suffix:
Gender:F
Credentials:LISW-S, CPHQ, CPHRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S 3RD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4206
Mailing Address - Country:US
Mailing Address - Phone:833-205-2030
Mailing Address - Fax:
Practice Address - Street 1:151 WOODSIDE PARK DR
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-8711
Practice Address - Country:US
Practice Address - Phone:513-882-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00102441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical