Healthcare Provider Details

I. General information

NPI: 1053089094
Provider Name (Legal Business Name): DIOSWAL COOK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CHAPEL DR
GRANVILLE OH
43023-6504
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 740-587-6200
  • Fax: 614-366-9489
Mailing address:
  • Phone: 740-587-6200
  • Fax: 614-366-9489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505043
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: