Provider Demographics
NPI:1164128385
Name:DIAZ, JASMINE BRIANNA (LCSWA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:BRIANNA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 WILLOWBLUE LN APT 108
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8317
Mailing Address - Country:US
Mailing Address - Phone:919-763-4384
Mailing Address - Fax:
Practice Address - Street 1:5760 WILLOWBLUE LN APT 108
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-8317
Practice Address - Country:US
Practice Address - Phone:919-763-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0181771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical