Provider Demographics
NPI:1023254927
Name:ANDREW COLVIN, PH.D., LLC
Entity type:Organization
Organization Name:ANDREW COLVIN, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-430-9870
Mailing Address - Street 1:7650 RIVERS EDGE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1342
Mailing Address - Country:US
Mailing Address - Phone:614-430-9870
Mailing Address - Fax:
Practice Address - Street 1:7650 RIVERS EDGE DR STE 140
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1342
Practice Address - Country:US
Practice Address - Phone:614-430-9870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5319261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health