Provider Demographics
NPI:1033232038
Name:DIANAHESTI, CHRISTINA (NCC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DIANAHESTI
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 WASSER CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-1135
Mailing Address - Country:US
Mailing Address - Phone:901-545-4660
Mailing Address - Fax:
Practice Address - Street 1:3171 DIRECTORS ROW
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38131-0405
Practice Address - Country:US
Practice Address - Phone:901-821-5841
Practice Address - Fax:901-821-5660
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527394Medicaid