Provider Demographics
NPI:1073121174
Name:ROYAL, GRAM CHRISTIAN (CDCA)
Entity type:Individual
Prefix:
First Name:GRAM
Middle Name:CHRISTIAN
Last Name:ROYAL
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 BLACKLICK EASTERN RD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8235
Mailing Address - Country:US
Mailing Address - Phone:614-762-7359
Mailing Address - Fax:
Practice Address - Street 1:1791 ALUM CREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1757
Practice Address - Country:US
Practice Address - Phone:614-445-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2024-06-01
Deactivation Date:2024-03-22
Deactivation Code:
Reactivation Date:2024-05-30
Provider Licenses
StateLicense IDTaxonomies
OH172154101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)