Provider Demographics
NPI:1841792678
Name:DIAZ, ANNA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:EICKSTAEDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7463 HARWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2663
Mailing Address - Country:US
Mailing Address - Phone:414-708-2985
Mailing Address - Fax:
Practice Address - Street 1:514 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3631
Practice Address - Country:US
Practice Address - Phone:262-548-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6780-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health