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General NPI Number Information
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NPI Number | 1598181240
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Entity Type | Individual
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Provider Name | SUSAN MARIE MOCNIAK LISW, CDCA
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Gender | Female
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 500 W WILSON BRIDGE RD SUITE 10
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City | WORTHINGTON
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State | OH
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Zip | 43085-2238
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Country | US
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Telephone | 614-721-8235
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Fax |
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Provider Business Mailing Address
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Address Line | 3536 WENWOOD DR
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City | HILLIARD
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State | OH
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Zip | 43026-2467
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Country | US
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Telephone | 614-354-6962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-1450715
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDC.141185-3
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License Number State | OH
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