Provider Demographics
NPI:1164501474
Name:DIAZ-GARCIA, AIDIL - (LPC-CSOTP)
Entity Type:Individual
Prefix:MS
First Name:AIDIL
Middle Name:-
Last Name:DIAZ-GARCIA
Suffix:
Gender:F
Credentials:LPC-CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MENOKIN DR
Mailing Address - Street 2:#103
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1706
Mailing Address - Country:US
Mailing Address - Phone:703-578-9746
Mailing Address - Fax:703-578-0868
Practice Address - Street 1:2400 MENOKIN DR
Practice Address - Street 2:#103
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1706
Practice Address - Country:US
Practice Address - Phone:703-578-9746
Practice Address - Fax:703-578-0868
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701003171101YP2500X
PR000291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical