Healthcare Provider Details

I. General information

NPI: 1356071468
Provider Name (Legal Business Name): MS. NINA CRADDOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 GAULT ST
COLUMBUS OH
43205-2933
US

IV. Provider business mailing address

PO BOX 15404
COLUMBUS OH
43215-0404
US

V. Phone/Fax

Practice location:
  • Phone: 614-216-1725
  • Fax:
Mailing address:
  • Phone: 614-588-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: