Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904009051 | VA |
NPI | 1003087925 |
---|---|
Provider Name | Ms. Diana Marcela Diaz |
First Address | Fairfax, VA 22031-4354 |
Second Address | Fairfax, VA 22031-4354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 26/01/2016 |