Healthcare Provider Details

I. General information

NPI: 1841698669
Provider Name (Legal Business Name): NORTHWOODS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 NORTHWOODS BLVD STE C1
COLUMBUS OH
43235-4720
US

IV. Provider business mailing address

92 NORTHWOODS BLVD STE C1
COLUMBUS OH
43235-4720
US

V. Phone/Fax

Practice location:
  • Phone: 614-841-9763
  • Fax: 614-846-1034
Mailing address:
  • Phone: 614-841-9763
  • Fax: 614-846-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number34.005463
License Number StateOH

VIII. Authorized Official

Name: DR. DALE ROBERT RICHARDS
Title or Position: PRINCIPAL/OWNER
Credential: D.O.
Phone: 614-841-9763