Provider Demographics
NPI:1619043718
Name:CONTRERAS, DIANE (LPCC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-0806
Mailing Address - Country:US
Mailing Address - Phone:505-454-9738
Mailing Address - Fax:505-425-9285
Practice Address - Street 1:1000 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9415
Practice Address - Country:US
Practice Address - Phone:505-454-9738
Practice Address - Fax:505-425-9285
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health