Provider Demographics
NPI:1225602923
Name:DE LA ROSA, DIANA BELINDA (LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:BELINDA
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:BELINDA
Other - Last Name:SALAIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3101 N CENTRAL AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2635
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:602-230-5105
Practice Address - Street 1:610 E BASELINE RD STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6536
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:602-441-5839
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional