Provider Demographics
NPI:1659907806
Name:DIAZ, DARLENE (BA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16825 119TH PL NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5462
Mailing Address - Country:US
Mailing Address - Phone:425-780-3496
Mailing Address - Fax:
Practice Address - Street 1:1808 RICHARDS RD STE 102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3982
Practice Address - Country:US
Practice Address - Phone:425-780-3496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61053528103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst