Healthcare Provider Details

I. General information

NPI: 1982134888
Provider Name (Legal Business Name): TASHA WILLAFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 BUTTERFLY GARDENS DR
COLUMBUS OH
43215-3427
US

IV. Provider business mailing address

PO BOX 78000
DETROIT MI
48278-1625
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8080
  • Fax: 614-355-4497
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.1700044
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1901470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: