Provider Demographics
NPI:1578019691
Name:DIAZ, VERONICA ITZEL (LMHCA)
Entity Type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:ITZEL
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 S ANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1712
Mailing Address - Country:US
Mailing Address - Phone:206-461-4880
Mailing Address - Fax:
Practice Address - Street 1:5837 221ST PL SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8917
Practice Address - Country:US
Practice Address - Phone:425-391-0887
Practice Address - Fax:425-391-7014
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WAMC61138067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor