Provider Demographics
NPI:1700202744
Name:MROZ, SHANDA I (LPCC, LICDC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:I
Last Name:MROZ
Suffix:
Gender:F
Credentials:LPCC, LICDC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 DELTA AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1127
Mailing Address - Country:US
Mailing Address - Phone:513-549-1227
Mailing Address - Fax:
Practice Address - Street 1:455 DELTA AVE STE 303
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1127
Practice Address - Country:US
Practice Address - Phone:513-549-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161841101YA0400X
OHE.2202971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)