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Individual

DR. HEIDAR A. MODARESI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
3060 WIMBLEDON LN, ROCK HILL, SC 29732-9249
(803) 366-9791
(803) 753-9522
Mailing address
3060 WIMBLEDON LN, ROCK HILL, SC 29732-9249
(803) 366-9791
(803) 753-9522

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0575
SC
101YM0800X
Mental Health Counselor
1973
NC
103T00000X
Psychologist
0575
SC
103T00000X
Psychologist
1973
NC
103TB0200X
Cognitive & Behavioral Psychologist
0575
SC
103TB0200X
Cognitive & Behavioral Psychologist
1973
NC
103TC0700X
Clinical Psychologist
Primary
0575
SC
103TC0700X
Clinical Psychologist
1973
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PS0221
SC
Enumeration date
05/18/2006
Last updated
09/02/2010
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