Provider Demographics
NPI:1124734124
Name:WARREN, DIAMOND B
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:B
Last Name:WARREN
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 1:169 W HURON ST UNIT 605
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3611
Mailing Address - Country:US
Mailing Address - Phone:312-806-1662
Mailing Address - Fax:
Practice Address - Street 1:169 W HURON ST UNIT 605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3611
Practice Address - Country:US
Practice Address - Phone:312-806-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011150101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor