Healthcare Provider Details

I. General information

NPI: 1124674072
Provider Name (Legal Business Name): NORTH DROP BACK IN ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 CLEVELAND AVE
COLUMBUS OH
43224-3644
US

IV. Provider business mailing address

3377 CLEVELAND AVE
COLUMBUS OH
43224-3644
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-4656
  • Fax:
Mailing address:
  • Phone: 614-252-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: GAMAL BROWN
Title or Position: SUPERINTENDENT
Credential: M.ED.
Phone: 614-252-4656