Provider Demographics
NPI:1114641842
Name:KOOHESTANI, SEENA
Entity Type:Individual
Prefix:
First Name:SEENA
Middle Name:
Last Name:KOOHESTANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5700
Mailing Address - Country:US
Mailing Address - Phone:980-412-8660
Mailing Address - Fax:
Practice Address - Street 1:328 S 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5700
Practice Address - Country:US
Practice Address - Phone:980-412-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health