Provider Demographics
NPI:1063052967
Name:PRINCE, TANICE A (LISW-S)
Entity type:Individual
Prefix:MS
First Name:TANICE
Middle Name:A
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 GRACELAND BLVD # 143
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1530
Mailing Address - Country:US
Mailing Address - Phone:614-427-2675
Mailing Address - Fax:
Practice Address - Street 1:118 GRACELAND BLVD # 143
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1530
Practice Address - Country:US
Practice Address - Phone:614-427-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2405586-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical