Healthcare Provider Details

I. General information

NPI: 1598428211
Provider Name (Legal Business Name): FORDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DORCHESTER SQ N STE 102
WESTERVILLE OH
43081-7305
US

IV. Provider business mailing address

100 DORCHESTER SQ N STE 102
WESTERVILLE OH
43081-7305
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-8262
  • Fax: 614-776-5333
Mailing address:
  • Phone: 614-890-8262
  • Fax: 614-776-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NORLINE FORD
Title or Position: COUNSELOR
Credential: LPC
Phone: 614-890-8262