Organization
EXCLUSIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY RENEE RAWLS MSW, LICDC (PRESIDENT/CEO)
(513) 827-9273
Entity
Organization
Contact information
Practice address
11134 LUSCHEK DR, BLUE ASH, OH 45241-2434
(513) 827-9273
(513) 818-9960
Mailing address
11134 LUSCHEK DR, BLUE ASH, OH 45241-2434
(513) 827-9273
(513) 818-9960
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM2800X
Methadone Clinic
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/25/2012
Last updated
02/01/2024
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