Provider Demographics
NPI:1659020345
Name:DIMOND, CALLIE (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:DIMOND
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22129 COUNTY ROAD 366
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-8650
Mailing Address - Country:US
Mailing Address - Phone:903-452-0890
Mailing Address - Fax:
Practice Address - Street 1:1221 JUDSON RD STE 1000
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3922
Practice Address - Country:US
Practice Address - Phone:903-452-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health