Provider Demographics
NPI:1154459758
Name:NAE, DIANA (MS, LCDP, RCS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NAE
Suffix:
Gender:F
Credentials:MS, LCDP, RCS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:CHEKRALLAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LCDP, RCS
Mailing Address - Street 1:200 HEROUX BLVD UNIT 202
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3628
Mailing Address - Country:US
Mailing Address - Phone:401-658-4369
Mailing Address - Fax:
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-732-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00376101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor