Provider Demographics
NPI:1841615515
Name:LARISGOITIA, DIANA CRISTINA (LPC PHD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CRISTINA
Last Name:LARISGOITIA
Suffix:
Gender:F
Credentials:LPC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CHESTNUT ST APT 3311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4385
Mailing Address - Country:US
Mailing Address - Phone:267-467-0520
Mailing Address - Fax:
Practice Address - Street 1:2400 CHESTNUT ST APT 3311
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4385
Practice Address - Country:US
Practice Address - Phone:267-467-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional