Provider Demographics
NPI:1679027007
Name:COLUMBUS VA
Entity Type:Organization
Organization Name:COLUMBUS VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUDVASH SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TORY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:614-388-7219
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-257-5200
Mailing Address - Fax:
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)