Provider Demographics
NPI:1871840231
Name:MOBLEY, DIAZINA CLINKSCALES
Entity Type:Individual
Prefix:
First Name:DIAZINA
Middle Name:CLINKSCALES
Last Name:MOBLEY
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 1:220 LOOKOUT PL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-8440
Mailing Address - Country:US
Mailing Address - Phone:407-579-2131
Mailing Address - Fax:
Practice Address - Street 1:220 LOOKOUT PL
Practice Address - Street 2:SUITE 150
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8440
Practice Address - Country:US
Practice Address - Phone:407-579-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW107501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical