Provider Demographics
NPI:1477209146
Name:FATKINS, INNA S
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:S
Last Name:FATKINS
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 1:2 EASTON OVAL STE 450
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6035
Mailing Address - Country:US
Mailing Address - Phone:614-475-9500
Mailing Address - Fax:614-475-9821
Practice Address - Street 1:2 EASTON OVAL STE 450
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6035
Practice Address - Country:US
Practice Address - Phone:614-475-9500
Practice Address - Fax:614-475-9821
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08265103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP.08265OtherOHIO BOARD OF PSYCHOLOGY