Healthcare Provider Details

I. General information

NPI: 1467970483
Provider Name (Legal Business Name): MILESTONE ADDICTION COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N MURRAY HILL RD
COLUMBUS OH
43228
US

IV. Provider business mailing address

106 N MURRAY HILL RD
COLUMBUS OH
43228-1524
US

V. Phone/Fax

Practice location:
  • Phone: 614-928-3663
  • Fax: 614-928-3664
Mailing address:
  • Phone: 614-928-3663
  • Fax: 614-928-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA DEAN
Title or Position: ADMIN
Credential:
Phone: 614-706-5206