Healthcare Provider Details

I. General information

NPI: 1598181240
Provider Name (Legal Business Name): SUSAN MARIE MOCNIAK LISW, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E STATE ST
COLUMBUS OH
43215-4281
US

IV. Provider business mailing address

3536 WENWOOD DR
HILLIARD OH
43026-2467
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 614-354-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDC.141185-3
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-1450715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: