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General NPI Number Information
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NPI Number | 1750937363
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Entity Type | Organization
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Legal Business Name | FREE SPIRIT COUNSELING LLC
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Dates
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Enumeration Date | 08/11/2019
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 1069 W BROAD ST STE 1008
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City | COLUMBUS
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State | OH
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Zip | 43222-1440
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Country | US
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Telephone | 614-681-1460
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Fax | 614-639-8228
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Provider Business Mailing Address
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Address Line | 5587 READERS ST
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-8328
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Country | US
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Telephone | 330-814-6384
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Fax |
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Authorized Official
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Title or Position | LICENSED INDEPENDENT SOCIAL WORKER
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Name | MRS. ACACIA GABRIELLE QUAINTANCE
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Credential | LISW
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Telephone | 330-814-6384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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