Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | MS |
NPI | 1134704737 |
---|---|
Provider Name | Emerson Nicolas Diaz |
First Address | Mendenhall, MS 39114-3076 |
Second Address | Mendenhall, MS 39114-3076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2021 |
Last Update Date | 15/03/2021 |