Provider Demographics
NPI:1386736122
Name:MOINZADEH, MOHAMAD (LPCC)
Entity type:Individual
Prefix:MR
First Name:MOHAMAD
Middle Name:
Last Name:MOINZADEH
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 SPRING GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-6938
Mailing Address - Country:US
Mailing Address - Phone:614-257-3106
Mailing Address - Fax:
Practice Address - Street 1:1492 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1546
Practice Address - Country:US
Practice Address - Phone:614-257-3106
Practice Address - Fax:614-257-3148
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3412101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health