Healthcare Provider Details

I. General information

NPI: 1679484588
Provider Name (Legal Business Name): PRISM PSYCHIATRIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4696 LANCASTER RD
GRANVILLE OH
43023-9509
US

IV. Provider business mailing address

4696 LANCASTER RD
GRANVILLE OH
43023-9509
US

V. Phone/Fax

Practice location:
  • Phone: 614-620-5297
  • Fax:
Mailing address:
  • Phone: 614-620-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY OPOKU-ANTWI
Title or Position: OWNER
Credential: NP
Phone: 614-620-5297