Provider Demographics
NPI:1891557666
Name:COGBURN, DIAMOND DEJA'RAI
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:DEJA'RAI
Last Name:COGBURN
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 1:415 GLENSPRINGS DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2354
Mailing Address - Country:US
Mailing Address - Phone:513-570-4068
Mailing Address - Fax:
Practice Address - Street 1:415 GLENSPRINGS DR STE 301
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-2354
Practice Address - Country:US
Practice Address - Phone:513-570-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty