Provider Demographics
NPI:1174285381
Name:FORREST, ADRAH
Entity Type:Individual
Prefix:MS
First Name:ADRAH
Middle Name:
Last Name:FORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1043
Mailing Address - Country:US
Mailing Address - Phone:614-352-2620
Mailing Address - Fax:614-675-2577
Practice Address - Street 1:1547 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1043
Practice Address - Country:US
Practice Address - Phone:614-352-2620
Practice Address - Fax:614-675-2577
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INLCDCII.161831101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)