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Individual
TARA IMMELE
Active
Individual
TARA IMMELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-S
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
161130
OH
1041C0700X
Clinical Social Worker
Primary
I 1500767
OH
Other
Enumeration date
07/11/2016
Last updated
12/12/2021
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