Healthcare Provider Details

I. General information

NPI: 1396169264
Provider Name (Legal Business Name): MR. ANDREW TOLLAFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 ATLAS ST
COLUMBUS OH
43228-9647
US

IV. Provider business mailing address

2140 ATLAS ST
COLUMBUS OH
43228-9647
US

V. Phone/Fax

Practice location:
  • Phone: 614-921-7000
  • Fax:
Mailing address:
  • Phone: 614-921-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: