Provider Demographics
NPI:1558157222
Name:MOHSENI-TABRIZI, PERSIA
Entity type:Individual
Prefix:
First Name:PERSIA
Middle Name:
Last Name:MOHSENI-TABRIZI
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 1:6038 GRAY GATE LN APT C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4079
Mailing Address - Country:US
Mailing Address - Phone:269-547-8918
Mailing Address - Fax:
Practice Address - Street 1:4501 CAMERON VALLEY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4298
Practice Address - Country:US
Practice Address - Phone:704-367-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health