Healthcare Provider Details

I. General information

NPI: 1518746627
Provider Name (Legal Business Name): CHARLES WILLIAM OWENS LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6877 N HIGH ST STE 305
WORTHINGTON OH
43085-2589
US

IV. Provider business mailing address

999 STONEY CREEK RD
COLUMBUS OH
43235-3454
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-1090
  • Fax: 614-751-1091
Mailing address:
  • Phone: 614-639-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0006038
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: