Basic Information
| Provider Information | |||||||||
| NPI: | 1265548812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPRAGUE | ||||||||
| FirstName: | GLORIA | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7214 HOPEWELL ST | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430172813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147662429 | ||||||||
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| Practice Location | |||||||||
| Address1: | 299 CRAMER CREEK CT | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430172586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148895722 | ||||||||
| FaxNumber: | 6148899335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E-0002850 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 981364 | 01 | OH | LICDC | OTHER |