Organization
SHELTER IN PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA WISEMAN LICDC (OWNER)
(740) 466-4103
Entity
Organization
Contact information
Practice address
3880 CLIME RD, COLUMBUS, OH 43228-3532
(740) 466-4103
Mailing address
90 E MAIN ST, WEST JEFFERSON, OH 43162-1206
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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