Provider Demographics
NPI:1376713289
Name:ANXIETY AND STRESS DISORDERS CLINIC
Entity Type:Organization
Organization Name:ANXIETY AND STRESS DISORDERS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:DECOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-292-9484
Mailing Address - Street 1:1835 NEIL AVE
Mailing Address - Street 2:105 PSYCHOLOGY BUILDING
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1351
Mailing Address - Country:US
Mailing Address - Phone:614-292-9484
Mailing Address - Fax:614-292-4539
Practice Address - Street 1:1835 NEIL AVE
Practice Address - Street 2:105 PSYCHOLOGY BUILDING
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1351
Practice Address - Country:US
Practice Address - Phone:614-292-9484
Practice Address - Fax:614-292-4539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE OHIO STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty