Provider Demographics
NPI:1215218953
Name:LOTT, DIAMOND DESHAE' (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:DESHAE'
Last Name:LOTT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:704-824-4999
Mailing Address - Fax:704-824-3999
Practice Address - Street 1:8440 PITSTOP CT. NW
Practice Address - Street 2:SUITE 140
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8245
Practice Address - Country:US
Practice Address - Phone:704-960-1729
Practice Address - Fax:980-225-7274
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11459235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist