Provider Demographics
NPI:1407339906
Name:DARVALICS, DIANA XIMENA (RBT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:XIMENA
Last Name:DARVALICS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 AKIKAI DR
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3968
Mailing Address - Country:US
Mailing Address - Phone:757-818-3384
Mailing Address - Fax:
Practice Address - Street 1:9230 OLD LORRAINE RD STE A
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6059
Practice Address - Country:US
Practice Address - Phone:228-731-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician