Provider Demographics
NPI:1609566520
Name:DIAZ, NICOLE RAE (DAC I)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DAC I
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RAE
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1850 WALNUT ST STE G
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-3611
Mailing Address - Country:US
Mailing Address - Phone:530-527-7893
Mailing Address - Fax:
Practice Address - Street 1:1850 WALNUT ST STE G
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3611
Practice Address - Country:US
Practice Address - Phone:530-527-7893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)