Provider Demographics
NPI:1205966181
Name:COLVIN, ANDREW NEIL (PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:NEIL
Last Name:COLVIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7870 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1319
Mailing Address - Country:US
Mailing Address - Phone:614-430-9870
Mailing Address - Fax:
Practice Address - Street 1:7870 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1319
Practice Address - Country:US
Practice Address - Phone:614-430-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5319103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical