Healthcare Provider Details

I. General information

NPI: 1124816632
Provider Name (Legal Business Name): HAILEY ANJOLIQUE BURKHOLDER LSW, LICDC, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4971 ARLINGTON CENTRE BLVD STE B
COLUMBUS OH
43220-3382
US

IV. Provider business mailing address

4971 ARLINGTON CENTRE BLVD STE B
COLUMBUS OH
43220-3382
US

V. Phone/Fax

Practice location:
  • Phone: 614-301-3546
  • Fax:
Mailing address:
  • Phone: 614-301-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2140840
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512094
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162894
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: