Provider Demographics
NPI:1205619913
Name:DIAZ, ANA MARIA (LCSW-A)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5229
Mailing Address - Country:US
Mailing Address - Phone:757-320-6232
Mailing Address - Fax:
Practice Address - Street 1:3622 LYCKAN PKWY STE 1001
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2565
Practice Address - Country:US
Practice Address - Phone:919-602-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0196261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical