Provider Demographics
NPI:1659957470
Name:AGHDAMI, SHIREEN A (LAC, LASAC)
Entity Type:Individual
Prefix:MS
First Name:SHIREEN
Middle Name:A
Last Name:AGHDAMI
Suffix:
Gender:F
Credentials:LAC, LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 E WATERMAN ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-2452
Mailing Address - Country:US
Mailing Address - Phone:480-789-3164
Mailing Address - Fax:
Practice Address - Street 1:7807 E GREENWAY RD STE 5
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1717
Practice Address - Country:US
Practice Address - Phone:480-789-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional