Healthcare Provider Details

I. General information

NPI: 1063387728
Provider Name (Legal Business Name): UPLIFT PATH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E BROAD ST
COLUMBUS OH
43215-5880
US

IV. Provider business mailing address

8 THE GRN STE 10386
DOVER DE
19901-3618
US

V. Phone/Fax

Practice location:
  • Phone: 513-299-4553
  • Fax:
Mailing address:
  • Phone: 513-299-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIA DONDI GILLIAM
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 614-344-1919