Healthcare Provider Details

I. General information

NPI: 1205305943
Provider Name (Legal Business Name): VANHAMM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 11/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 N HIGH ST STE 208
WORTHINGTON OH
43085-3948
US

IV. Provider business mailing address

5655 N HIGH ST STE 208
WORTHINGTON OH
43085-3948
US

V. Phone/Fax

Practice location:
  • Phone: 614-505-6977
  • Fax: 614-505-3548
Mailing address:
  • Phone: 614-505-6977
  • Fax: 614-505-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANUTE VANBEYSTERVELDT
Title or Position: OWNER
Credential: LPCC
Phone: 614-354-6688