Healthcare Provider Details

I. General information

NPI: 1457170391
Provider Name (Legal Business Name): COLUMBUS COUNSELING AND MENTORING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 BOTSFORD DR
COLUMBUS OH
43232-4503
US

IV. Provider business mailing address

4955 BOTSFORD DR
COLUMBUS OH
43232-4503
US

V. Phone/Fax

Practice location:
  • Phone: 614-615-4500
  • Fax:
Mailing address:
  • Phone: 614-615-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JOI ADELL
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 614-615-4500