Provider Demographics
NPI:1891856647
Name:VINES, DIANA SIMMS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:SIMMS
Last Name:VINES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 CAMINITO VELEZ
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5726
Mailing Address - Country:US
Mailing Address - Phone:858-459-8248
Mailing Address - Fax:
Practice Address - Street 1:1881 CAMINITO VELEZ
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5726
Practice Address - Country:US
Practice Address - Phone:858-459-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17702103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling