Provider Demographics
NPI:1275056988
Name:MILTON, LARRY DARNELL (LICDC-CS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DARNELL
Last Name:MILTON
Suffix:
Gender:M
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ATCHESON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1353
Mailing Address - Country:US
Mailing Address - Phone:614-252-4941
Mailing Address - Fax:614-246-2029
Practice Address - Street 1:1000 ATCHESON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1353
Practice Address - Country:US
Practice Address - Phone:614-252-4941
Practice Address - Fax:614-246-2029
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965730101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)