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NPI Code Detail

MEDICARE: SIMON R. WOLIVER LPCC-S, LICDC

MEDICARE: SIMON R. WOLIVER LPCC-S, LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.141209OH
2101YP2500XProfessional CounselorE.1300025-SUPVOH

General Provider Information

NPI Number : 1457877789
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMON R. WOLIVER LPCC-S, LICDC
Provider Business Mailing Address
First Line : 1768 GLENN AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43212-2035
Country : US
Telephone Number : 513-535-5852
Fax Number :
Provider Business Practice Location Address
First Line : 5354 N HIGH ST STE 206
Second Line :
City : COLUMBUS
State : OH
Zip : 43214-1274
Country : US
Telephone Number : 614-948-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2017
Last Update Date : 03/17/2018

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