Provider Demographics
NPI:1851840490
Name:CLINTONVILLE COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:CLINTONVILLE COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RHONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:614-948-7300
Mailing Address - Street 1:5354 N HIGH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1295
Mailing Address - Country:US
Mailing Address - Phone:614-948-7300
Mailing Address - Fax:
Practice Address - Street 1:5354 N. HIGH ST.
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-2365
Practice Address - Country:US
Practice Address - Phone:614-948-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0602072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty