Healthcare Provider Details

I. General information

NPI: 1629907050
Provider Name (Legal Business Name): SURVIVE TO THRIVE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE STE 110
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

4770 INDIANOLA AVE STE 110
COLUMBUS OH
43214-1862
US

V. Phone/Fax

Practice location:
  • Phone: 614-206-4321
  • Fax:
Mailing address:
  • Phone: 614-206-4321
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELETTA L FAIR
Title or Position: FOUNDER
Credential: CDCA, QMHS LL
Phone: 614-680-3828