Provider Demographics
NPI:1376797936
Name:CHERYL COLVIN, PH.D., LLC
Entity Type:Organization
Organization Name:CHERYL COLVIN, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-848-5154
Mailing Address - Street 1:7650 RIVERS EDGE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1342
Mailing Address - Country:US
Mailing Address - Phone:614-848-5154
Mailing Address - Fax:614-841-1957
Practice Address - Street 1:7650 RIVERS EDGE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1342
Practice Address - Country:US
Practice Address - Phone:614-848-5154
Practice Address - Fax:614-841-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5251103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty