=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083561336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | O'NEAL LEGACY CONNECTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2026
-----------------------------------------------------
Last Update Date | 03/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3442 RIVERSIDE DR
-----------------------------------------------------
City | UPPER ARLINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43221-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-859-0213
-----------------------------------------------------
Fax | 614-352-2379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3442 RIVERSIDE DR
-----------------------------------------------------
City | UPPER ARLINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43221-1743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-859-0213
-----------------------------------------------------
Fax | 614-352-2379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL DIRECTOR
-----------------------------------------------------
Name | DR. DEMETRA T TAYLOR
-----------------------------------------------------
Credential | PHD, LPCC
-----------------------------------------------------
Telephone | 614-859-0213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------