Healthcare Provider Details

I. General information

NPI: 1932739174
Provider Name (Legal Business Name): NORLINE E FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DORCHESTER SQ. SUITE 102
WESTERVILLE OH
43081
US

IV. Provider business mailing address

2920 BLUE TOP DRIVE
COLUMBUS OH
43232
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-8262
  • Fax:
Mailing address:
  • Phone: 614-499-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: