Healthcare Provider Details

I. General information

NPI: 1063052967
Provider Name (Legal Business Name): TANICE A PRINCE LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S SANDUSKY ST STE 258
DELAWARE OH
43015-2621
US

IV. Provider business mailing address

175 S SANDUSKY ST STE 258
DELAWARE OH
43015-2621
US

V. Phone/Fax

Practice location:
  • Phone: 614-285-4144
  • Fax:
Mailing address:
  • Phone: 614-285-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405586-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: