Individual
ELLICE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4449 EASTON WAY STE 200, COLUMBUS, OH 43219
(614) 568-3233
Mailing address
PO BOX 910 LOT 1210, COLUMBUS, OH 43216
(614) 568-3233
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
150556
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
150556
OH
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
Primary
150556
OH
101YP2500X
Professional Counselor
C.1500556
OH
101YS0200X
School Counselor
150556
OH
171000000X
Military Health Care Provider
—
—
171400000X
Health & Wellness Coach
—
—
Other
Enumeration date
10/12/2016
Last updated
09/03/2021
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