Provider Demographics
NPI:1083693238
Name:DAGENFIELD, EDWARD SCOTT (LICDC, LPC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:SCOTT
Last Name:DAGENFIELD
Suffix:
Gender:M
Credentials:LICDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3301
Mailing Address - Country:US
Mailing Address - Phone:614-481-0770
Mailing Address - Fax:614-444-1482
Practice Address - Street 1:691 S 5TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2120
Practice Address - Country:US
Practice Address - Phone:614-443-6155
Practice Address - Fax:614-444-1482
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH85225101YA0400X
OHC5409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional