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General NPI Number Information
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NPI Number | 1417772971
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Entity Type | Organization
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Legal Business Name | OHIO CENTER FOR ADOLESCENT WELLNESS LLC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 150 E WILSON BRIDGE RD STE 100
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City | WORTHINGTON
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State | OH
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Zip | 43085-2328
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Country | US
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Telephone | 888-920-6370
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E WILSON BRIDGE RD STE 100
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City | WORTHINGTON
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State | OH
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Zip | 43085-2328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | EDWARD THATCHER
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Credential |
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Telephone | 754-217-8127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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