Healthcare Provider Details

I. General information

NPI: 1114528775
Provider Name (Legal Business Name): TRINKA LOUISE GLENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 E BROAD ST # F14
COLUMBUS OH
43213-2086
US

IV. Provider business mailing address

6400 E BROAD ST # F14
COLUMBUS OH
43213-2086
US

V. Phone/Fax

Practice location:
  • Phone: 614-655-3345
  • Fax:
Mailing address:
  • Phone: 614-655-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.178800
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: