Provider Demographics
NPI:1689141152
Name:DIAZ, VIOLETA (LPC)
Entity Type:Individual
Prefix:MS
First Name:VIOLETA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:VIOLETA
Other - Middle Name:DIAZ
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:600 E GRIFFIN PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2980
Mailing Address - Country:US
Mailing Address - Phone:956-600-7123
Mailing Address - Fax:956-600-7101
Practice Address - Street 1:600 E GRIFFIN PKWY STE B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2980
Practice Address - Country:US
Practice Address - Phone:956-600-7123
Practice Address - Fax:956-600-7101
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$Medicaid