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General NPI Number Information
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NPI Number | 1952864217
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Entity Type | Organization
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Legal Business Name | THERACARE COUNSELING & CONSULTING
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 4200 REGENT ST STE 200
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City | COLUMBUS
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State | OH
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Zip | 43219-6229
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Country | US
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Telephone | 614-376-9194
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Fax |
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Provider Business Mailing Address
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Address Line | 4876 BETULA DR
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-7043
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Country | US
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Telephone | 614-376-9194
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIQUE MARTIN
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Credential |
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Telephone | 614-376-9194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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