Provider Demographics
NPI:1942444872
Name:FUJIWARA, MEMIKO (PC)
Entity Type:Individual
Prefix:
First Name:MEMIKO
Middle Name:
Last Name:FUJIWARA
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W STATE ST
Mailing Address - Street 2:#J7
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3620 N HIGH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3611
Practice Address - Country:US
Practice Address - Phone:614-263-8161
Practice Address - Fax:614-263-8268
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0700312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health