Healthcare Provider Details

I. General information

NPI: 1306569025
Provider Name (Legal Business Name): MR. JOSHUA JAMES CHAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W BROAD ST
COLUMBUS OH
43204-1306
US

IV. Provider business mailing address

3394 BINBROOK RD N
COLUMBUS OH
43227-3511
US

V. Phone/Fax

Practice location:
  • Phone: 614-869-2002
  • Fax: 614-792-6240
Mailing address:
  • Phone: 856-239-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number189725
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0002369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: