Provider Demographics
NPI:1710341086
Name:DIAZ-PAZ, AMIE MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:MICHELLE
Last Name:DIAZ-PAZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:MICHELLE
Other - Last Name:CHARLERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CALIFORNIA ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5424
Mailing Address - Country:US
Mailing Address - Phone:800-997-6196
Mailing Address - Fax:833-523-9924
Practice Address - Street 1:100 SHOCKOE SLIP FL 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-4100
Practice Address - Country:US
Practice Address - Phone:800-997-6196
Practice Address - Fax:833-523-9924
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945247Medicaid