Provider Demographics
NPI:1245889096
Name:DIAMANTIS, ANNA (LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DIAMANTIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 POST RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5916
Mailing Address - Country:US
Mailing Address - Phone:203-442-5566
Mailing Address - Fax:
Practice Address - Street 1:1506 POST RD STE 1
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5916
Practice Address - Country:US
Practice Address - Phone:203-442-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional