Provider Demographics
NPI:1033651658
Name:BOARD, YOLANDA ISELA (LPCC-S)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:ISELA
Last Name:BOARD
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:MS
Other - First Name:YOLANDA
Other - Middle Name:ISELA
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:600 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-4129
Mailing Address - Country:US
Mailing Address - Phone:937-728-9787
Mailing Address - Fax:
Practice Address - Street 1:1948 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2648
Practice Address - Country:US
Practice Address - Phone:866-534-2639
Practice Address - Fax:800-480-7578
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800923-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293671Medicaid