Provider Demographics
NPI:1770026254
Name:DIAZ YABUKU, LIZBETH
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:DIAZ YABUKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 COLLIER RD NW
Mailing Address - Street 2:F3
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2941
Mailing Address - Country:US
Mailing Address - Phone:678-591-4387
Mailing Address - Fax:
Practice Address - Street 1:900 CIRCLE 75 PKWY SE
Practice Address - Street 2:SUITE 1435
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3035
Practice Address - Country:US
Practice Address - Phone:678-591-4387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health