Provider Demographics
NPI:1619533189
Name:MOHIUDDIN, SANA FATIMA (LPC-IT)
Entity Type:Individual
Prefix:
First Name:SANA
Middle Name:FATIMA
Last Name:MOHIUDDIN
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 S 35TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-4611
Mailing Address - Country:US
Mailing Address - Phone:224-628-0249
Mailing Address - Fax:
Practice Address - Street 1:8500 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-2844
Practice Address - Country:US
Practice Address - Phone:414-252-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4326-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional