Healthcare Provider Details

I. General information

NPI: 1649839531
Provider Name (Legal Business Name): KIMBERLY A. JOHNSON-NEELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W BROAD ST
COLUMBUS OH
43204-1306
US

IV. Provider business mailing address

647 BELVIDERE AVE
COLUMBUS OH
43223-1718
US

V. Phone/Fax

Practice location:
  • Phone: 614-869-2002
  • Fax: 614-792-6240
Mailing address:
  • Phone: 614-822-7392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.002725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: