Modaresi, Heidar A.
Modaresi, Heidar A. is an sole proprietor health care provider with primary practice located at 3060 Wimbledon Ln , Rock Hill SC 29732-9249. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Modaresi, Heidar A. can be contacted via phone (803) 366-9791.Contact Information
Primary practice address
3060 Wimbledon Ln
Rock Hill SC 29732-9249
Phone: (803) 366-9791
Fax: (803) 753-9522
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 1973 | North Carolina |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 0575 | South Carolina |
| Behavioral Health & Social Service Providers / Cognitive & Behavioral | 103TB0200X | 0575 | South Carolina |
| Behavioral Health & Social Service Providers / Cognitive & Behavioral | 103TB0200X | 1973 | North Carolina |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 0575 | South Carolina |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 1973 | North Carolina |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 0575 | South Carolina |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 1973 | North Carolina |
Profile Details
| NPI number | 1619920980 |
|---|---|
| LBN Legal business name | Modaresi, Heidar A. |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 18th, 2006 |
| Last updated | Sep 2nd, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619920980 | NPPES |
| South Carolina | MEDICAID | PS0221 |
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