Provider Demographics
NPI:1679922306
Name:KARLA L DIFFIN, INC
Entity Type:Organization
Organization Name:KARLA L DIFFIN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-330-1834
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211-2074
Mailing Address - Country:US
Mailing Address - Phone:207-330-1834
Mailing Address - Fax:
Practice Address - Street 1:3 WALCOTT ST
Practice Address - Street 2:
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281-5924
Practice Address - Country:US
Practice Address - Phone:207-330-1834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1355103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty