Healthcare Provider Details

I. General information

NPI: 1003658139
Provider Name (Legal Business Name): CHARMAYNE ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 PARKWICK DR STE 100
COLUMBUS OH
43228-6401
US

IV. Provider business mailing address

4725 PARKWICK DR STE 100
COLUMBUS OH
43228-6401
US

V. Phone/Fax

Practice location:
  • Phone: 614-655-3354
  • Fax:
Mailing address:
  • Phone: 380-233-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2512832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: