Basic Information
| Provider Information | |||||||||
| NPI: | 1932619970 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WHITEHALL CAP INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WCAP COUNSELING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 BRICE RD | ||||||||
| Address2: | |||||||||
| City: | REYNOLDSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430683403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142399965 | ||||||||
| FaxNumber: | 6142399971 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 BRICE RD | ||||||||
| Address2: | |||||||||
| City: | REYNOLDSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142399965 | ||||||||
| FaxNumber: | 6142399971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2017 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCVAY | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | STAFFING, | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6142399965 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 14219 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 14219 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 14219 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101Y00000X | 14219 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 14219 | 01 | OH | OHIO DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES | OTHER |