Provider Demographics
NPI:1295293033
Name:ADIB, NOOSHIN (LPC COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:NOOSHIN
Middle Name:
Last Name:ADIB
Suffix:
Gender:F
Credentials:LPC COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 E SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3114
Mailing Address - Country:US
Mailing Address - Phone:928-350-7503
Mailing Address - Fax:
Practice Address - Street 1:4319 N DRYDEN ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-9397
Practice Address - Country:US
Practice Address - Phone:928-350-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional