Healthcare Provider Details

I. General information

NPI: 1073839635
Provider Name (Legal Business Name): RODA HASSAN LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BRYDEN RD STE 204
COLUMBUS OH
43215-4839
US

IV. Provider business mailing address

700 BRYDEN RD STE 204
COLUMBUS OH
43215-4839
US

V. Phone/Fax

Practice location:
  • Phone: 614-473-9500
  • Fax: 614-473-9545
Mailing address:
  • Phone: 614-473-9500
  • Fax: 614-473-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: