Provider Demographics
NPI:1407063902
Name:JULIAN, DIANA MARIE (CAADE)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MARIE
Last Name:JULIAN
Suffix:
Gender:F
Credentials:CAADE
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:HODGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1365 N JOHNSON AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1676
Mailing Address - Country:US
Mailing Address - Phone:619-441-2493
Mailing Address - Fax:619-442-1592
Practice Address - Street 1:1365 N JOHNSON AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1676
Practice Address - Country:US
Practice Address - Phone:619-441-2493
Practice Address - Fax:619-442-1592
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA071426101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)