Provider Demographics
NPI:1215358379
Name:DIAZ, ALICE (LPCA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BOGLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3823
Mailing Address - Country:US
Mailing Address - Phone:606-676-0638
Mailing Address - Fax:
Practice Address - Street 1:401 BOGLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3823
Practice Address - Country:US
Practice Address - Phone:606-676-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health