Healthcare Provider Details

I. General information

NPI: 1982834974
Provider Name (Legal Business Name): SPIRIT OF PEACE CLINICAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 OLD HENDERSON RD SUITE 100
COLUMBUS OH
43220-3623
US

IV. Provider business mailing address

1170 OLD HENDERSON RD SUITE 100
COLUMBUS OH
43220-3623
US

V. Phone/Fax

Practice location:
  • Phone: 614-442-7650
  • Fax: 614-442-7656
Mailing address:
  • Phone: 614-442-7650
  • Fax: 614-442-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberE0500951
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0500951
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0500951
License Number StateOH

VIII. Authorized Official

Name: MRS. MICHELE ANN MELARAGNO
Title or Position: PRIMARY OFFICER
Credential: LPCC-S
Phone: 614-442-7650