Healthcare Provider Details

I. General information

NPI: 1285198341
Provider Name (Legal Business Name): DONNA LYNNE POPPENDIECK LICDC-CS, OCPSII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4766 SHELL CT S
COLUMBUS OH
43213-2048
US

IV. Provider business mailing address

4766 SHELL CT S
COLUMBUS OH
43213-2048
US

V. Phone/Fax

Practice location:
  • Phone: 614-209-7889
  • Fax:
Mailing address:
  • Phone: 614-209-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number0939-C03
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001355
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: