Provider Demographics
NPI:1053089094
Name:COOK, DIOSWAL (LPCC)
Entity type:Individual
Prefix:
First Name:DIOSWAL
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:740-587-6200
Mailing Address - Fax:614-366-9489
Practice Address - Street 1:550 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-6504
Practice Address - Country:US
Practice Address - Phone:740-587-6200
Practice Address - Fax:614-366-9489
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204280101Y00000X, 101YP2500X
OHE.2505043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0459143Medicaid