Healthcare Provider Details

I. General information

NPI: 1932892734
Provider Name (Legal Business Name): ERICA THEISEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 CHANNINGWAY BLVD STE 606
COLUMBUS OH
43232-2999
US

IV. Provider business mailing address

6100 CHANNINGWAY BLVD STE 606
COLUMBUS OH
43232-2999
US

V. Phone/Fax

Practice location:
  • Phone: 614-636-6920
  • Fax:
Mailing address:
  • Phone: 614-636-6920
  • Fax: 513-354-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2406066
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2304690-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: