Provider Demographics
NPI:1053456129
Name:HELENE, NINA (EDD, LSW, LICDC)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:HELENE
Suffix:
Gender:F
Credentials:EDD, LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2690
Mailing Address - Country:US
Mailing Address - Phone:888-236-4035
Mailing Address - Fax:614-586-1879
Practice Address - Street 1:1115 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2690
Practice Address - Country:US
Practice Address - Phone:888-236-4035
Practice Address - Fax:614-586-1879
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS10194, LICDC 944028171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor