Healthcare Provider Details

I. General information

NPI: 1619601655
Provider Name (Legal Business Name): ELIZABETH KAKUNGULU CLINICAL COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HORIZONS DR STE 213
COLUMBUS OH
43220-0019
US

IV. Provider business mailing address

4100 HORIZONS DR STE 213
COLUMBUS OH
43220-0019
US

V. Phone/Fax

Practice location:
  • Phone: 614-858-5100
  • Fax: 614-858-5180
Mailing address:
  • Phone: 614-858-5100
  • Fax: 161-485-8518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH KAKUNGULU
Title or Position: OWNER
Credential: LISW-S
Phone: 614-858-5100