Healthcare Provider Details

I. General information

NPI: 1891662664
Provider Name (Legal Business Name): ROBERT MANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 E BROAD ST
COLUMBUS OH
43205-1404
US

IV. Provider business mailing address

1243 E BROAD ST
COLUMBUS OH
43205-1404
US

V. Phone/Fax

Practice location:
  • Phone: 614-321-7734
  • Fax:
Mailing address:
  • Phone: 614-321-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.194607
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number75598602
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: