Basic Information
| Provider Information | |||||||||
| NPI: | 1831182922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH COMMUNITY COUNSELING CTRS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4897 KARL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432295147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142697003 | ||||||||
| FaxNumber: | 6142677013 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432043783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142797690 | ||||||||
| FaxNumber: | 6142797695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 05/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | KITTREDGE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6142377003 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC2200X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 2499783 | 05 | OH | MEDICAID |