Provider Demographics
NPI:1700353489
Name:ROSS, DONN DAVID (MS, LICDC)
Entity type:Individual
Prefix:MR
First Name:DONN
Middle Name:DAVID
Last Name:ROSS
Suffix:
Gender:M
Credentials:MS, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3393 HINES RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2063
Mailing Address - Country:US
Mailing Address - Phone:614-657-9476
Mailing Address - Fax:
Practice Address - Street 1:3393 HINES RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2063
Practice Address - Country:US
Practice Address - Phone:614-657-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161444101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)