Provider Demographics
NPI:1699069195
Name:LOUGHERY, JOHANNA M (CDCA, RA, BA)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:M
Last Name:LOUGHERY
Suffix:
Gender:F
Credentials:CDCA, RA, BA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2600 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1711
Mailing Address - Country:US
Mailing Address - Phone:513-751-7747
Mailing Address - Fax:513-751-0180
Practice Address - Street 1:759 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1754
Practice Address - Country:US
Practice Address - Phone:513-932-4337
Practice Address - Fax:513-751-7747
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)