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General NPI Number Information
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NPI Number | 1720883937
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Entity Type | Organization
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Legal Business Name | COLUMBUS ICE
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 4532 KATHERINE DR
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City | COLUMBUS
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State | OH
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Zip | 43232-5646
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Country | US
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Telephone | 347-245-1588
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Fax |
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Provider Business Mailing Address
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Address Line | 4532 KATHERINE DR
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City | COLUMBUS
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State | OH
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Zip | 43232-5646
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Country | US
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Telephone | 347-245-1588
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | CHRISTINA M COLON
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Credential |
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Telephone | 614-233-1423
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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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