Provider Demographics
NPI:1972165322
Name:DAIGLE, DIANA (MS, RMHCI)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:MS, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28042 BRIDGETOWN CT UNIT 4613
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8997
Mailing Address - Country:US
Mailing Address - Phone:239-273-1401
Mailing Address - Fax:
Practice Address - Street 1:2503 DEL PRADO BLVD S STE 410
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5709
Practice Address - Country:US
Practice Address - Phone:239-443-6385
Practice Address - Fax:239-242-6389
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-06
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty