Organization
EXCLUSIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY RAWLS MSW, LICDC 07 MSW, LICDC (CEO/FOUNDER)
(513) 827-9273
Entity
Organization
Contact information
Practice address
11134 LUSCHEK DR, BLUE ASH, OH 45241-2434
(513) 827-9273
Mailing address
11134 LUSCHEK DR, BLUE ASH, OH 45241-2434
(513) 827-9273
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0064132
—
OH
01
—
CL02255465003
OHIO PHARMACY BOARD LICENSE
OH
Enumeration date
07/12/2016
Last updated
07/12/2016
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