Healthcare Provider Details

I. General information

NPI: 1255706651
Provider Name (Legal Business Name): CANDACE S BOHANAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 E LIVINGSTON AVE
COLUMBUS OH
43205-2838
US

IV. Provider business mailing address

5000 CARBONDALE DR
COLUMBUS OH
43232-4559
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-8834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1600612
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: