Provider Demographics
NPI:1497346753
Name:HARGROVE, DAIZAH
Entity Type:Individual
Prefix:MISS
First Name:DAIZAH
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 PHILLIPS RD APT 4201
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5379
Mailing Address - Country:US
Mailing Address - Phone:786-674-3054
Mailing Address - Fax:
Practice Address - Street 1:2350 PHILLIPS RD APT 4201
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5379
Practice Address - Country:US
Practice Address - Phone:786-674-3054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty