Provider Demographics
NPI:1447058276
Name:COSPER, OCTAVIA ANTOINETTE
Entity type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:ANTOINETTE
Last Name:COSPER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-1388
Mailing Address - Country:US
Mailing Address - Phone:614-423-6299
Mailing Address - Fax:
Practice Address - Street 1:3350 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-1388
Practice Address - Country:US
Practice Address - Phone:614-423-6299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.191758101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)