Healthcare Provider Details

I. General information

NPI: 1598639429
Provider Name (Legal Business Name): NICOLE BINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3989 BROADWAY STE 1032
GROVE CITY OH
43123-2639
US

IV. Provider business mailing address

3989 BROADWAY STE 1032
GROVE CITY OH
43123-2639
US

V. Phone/Fax

Practice location:
  • Phone: 614-377-6749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS006834
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195157
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: