Provider Demographics
NPI:1073692133
Name:REDEEMER, DIANA (MA, LPCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:REDEEMER
Suffix:
Gender:F
Credentials:MA, LPCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5595 CANDLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-5808
Mailing Address - Country:US
Mailing Address - Phone:805-587-0179
Mailing Address - Fax:
Practice Address - Street 1:5595 CANDLEBERRY LN
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-5808
Practice Address - Country:US
Practice Address - Phone:805-587-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009080101YM0800X
CALPCC13013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382143740OtherTAX ID
MI730195Medicaid