Provider Demographics
NPI:1790152049
Name:SANMIGUEL, DIANA (LMHC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SANMIGUEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13180 N CLEVELAND AVE STE 339
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-6232
Mailing Address - Country:US
Mailing Address - Phone:239-402-4010
Mailing Address - Fax:
Practice Address - Street 1:13180 N CLEVELAND AVE STE 339
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-6232
Practice Address - Country:US
Practice Address - Phone:239-402-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19552101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health