Basic Information
| Provider Information | |||||||||
| NPI: | 1407830763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCALL | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCD,LISW,LICDC,ICADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5844 BEAR CREEK DR | ||||||||
| Address2: | |||||||||
| City: | BEDFORD HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441462960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407868222 | ||||||||
| FaxNumber: | 4407867505 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | BEDFORD HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441463642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404399250 | ||||||||
| FaxNumber: | 4404395984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 09/29/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 981034 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | I-0008746 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1508058736 | 01 | SUCCESS 1 SERVICES, LLC | OTHER |