Healthcare Provider Details

I. General information

NPI: 1457913022
Provider Name (Legal Business Name): MARISSA ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 E DUBLIN GRANVILLE RD STE 420
COLUMBUS OH
43229-3245
US

IV. Provider business mailing address

665 E DUBLIN GRANVILLE RD STE 420
COLUMBUS OH
43229-3245
US

V. Phone/Fax

Practice location:
  • Phone: 614-396-7056
  • Fax:
Mailing address:
  • Phone: 614-396-7056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2303676
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: