Provider Demographics
NPI:1346857687
Name:DIAZ, JAIRO (NCC, CRC)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E DIAMOND AVE STE H
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-5328
Mailing Address - Country:US
Mailing Address - Phone:240-907-6203
Mailing Address - Fax:
Practice Address - Street 1:620 E DIAMOND AVE STE H
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5328
Practice Address - Country:US
Practice Address - Phone:240-907-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health