Provider Demographics
NPI:1033868930
Name:DIVERSITY COUNSELING LLC
Entity Type:Organization
Organization Name:DIVERSITY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:CRUZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LCDCS, SAP
Authorized Official - Phone:401-396-7649
Mailing Address - Street 1:111 WAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4371
Mailing Address - Country:US
Mailing Address - Phone:401-396-7649
Mailing Address - Fax:
Practice Address - Street 1:111 WAYLAND AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4371
Practice Address - Country:US
Practice Address - Phone:401-396-7649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-20
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty