Healthcare Provider Details

I. General information

NPI: 1023793791
Provider Name (Legal Business Name): PAULENA RIVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 04/27/2024
Certification Date: 04/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 E BROAD ST
COLUMBUS OH
43213-1064
US

IV. Provider business mailing address

140 E TOWN ST STE 1450
COLUMBUS OH
43215-5125
US

V. Phone/Fax

Practice location:
  • Phone: 380-201-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.188170
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: