Provider Demographics
NPI:1245353978
Name:DIAS, CHRISTINE O'MEARA (LCMHC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:O'MEARA
Last Name:DIAS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:MANOMET
Mailing Address - State:MA
Mailing Address - Zip Code:02345-0694
Mailing Address - Country:US
Mailing Address - Phone:603-662-8908
Mailing Address - Fax:781-936-8241
Practice Address - Street 1:225 WATER ST STE A10
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4060
Practice Address - Country:US
Practice Address - Phone:603-662-8908
Practice Address - Fax:781-936-8241
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424834Medicaid