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General NPI Number Information
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NPI Number | 1346751401
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS DYSLEXIA & LEARNING CENTER OF COLUMBUS, LLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 424 WASHINGTON ST STE 7
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City | COLUMBUS
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State | IN
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Zip | 47201-6790
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Country | US
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Telephone | 812-657-4784
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Fax | 812-379-8068
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Provider Business Mailing Address
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Address Line | 450 JACKSON ST UNIT 1495
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City | COLUMBUS
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State | IN
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Zip | 47201-6783
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Country | US
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Telephone | 812-657-4784
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Fax | 812-379-8068
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Authorized Official
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Title or Position | DIRECTOR/CLINICAL PSYCHOLOGIST
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Name | DR. DAWN A DOUP
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Credential | PSY.D.
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Telephone | 812-657-4784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20042503A
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License Number State | IN
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