Provider Demographics
NPI:1487017943
Name:CORTINA-RODRIGUEZ, DIANA DENISE (LAMFT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DENISE
Last Name:CORTINA-RODRIGUEZ
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8307
Mailing Address - Country:US
Mailing Address - Phone:470-377-3016
Mailing Address - Fax:
Practice Address - Street 1:2876 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8307
Practice Address - Country:US
Practice Address - Phone:470-377-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAAMFT000343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist