Provider Demographics
NPI:1245696111
Name:DIRIR, AYAN MOHAMED (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:AYAN
Middle Name:MOHAMED
Last Name:DIRIR
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MURTHAS WAY APT 135
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2645
Mailing Address - Country:US
Mailing Address - Phone:240-390-6320
Mailing Address - Fax:
Practice Address - Street 1:2030 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1831
Practice Address - Country:US
Practice Address - Phone:203-558-1143
Practice Address - Fax:203-490-4244
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6498101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional