Healthcare Provider Details

I. General information

NPI: 1952224537
Provider Name (Legal Business Name): MARY CULVER CDCA PRELIMINARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4182 WORTH AVE
COLUMBUS OH
43219-1535
US

IV. Provider business mailing address

1255 N HAMILTON RD
GAHANNA OH
43230-6785
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8965
  • Fax:
Mailing address:
  • Phone: 614-356-8965
  • Fax: 614-356-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195764
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: