Healthcare Provider Details

I. General information

NPI: 1013623818
Provider Name (Legal Business Name): UNIK FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E DUBLIN GRANVILLE RD STE 236
COLUMBUS OH
43229-3517
US

IV. Provider business mailing address

1925 E DUBLIN GRANVILLE RD STE 236
COLUMBUS OH
43229-3517
US

V. Phone/Fax

Practice location:
  • Phone: 614-987-5100
  • Fax:
Mailing address:
  • Phone: 614-987-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. HANAD DUALE
Title or Position: PRESIDENT
Credential: PHD
Phone: 614-987-5100