Provider Demographics
NPI:1922820075
Name:DIAZ, RENEE ERICA (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ERICA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 HADLEY RUN
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5346
Mailing Address - Country:US
Mailing Address - Phone:830-391-9806
Mailing Address - Fax:
Practice Address - Street 1:1811 S LAREDO ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-7019
Practice Address - Country:US
Practice Address - Phone:210-744-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health