Provider Demographics
NPI:1457862401
Name:INTRINSIC CONNECTIONS COUNSELING
Entity Type:Organization
Organization Name:INTRINSIC CONNECTIONS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCC-S
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-546-7939
Mailing Address - Street 1:1016 S HIGH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2567
Mailing Address - Country:US
Mailing Address - Phone:614-546-7939
Mailing Address - Fax:
Practice Address - Street 1:1016 S HIGH ST FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206
Practice Address - Country:US
Practice Address - Phone:614-546-7939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008253-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty