Provider Demographics
NPI:1245926310
Name:STEPHENS, DIAMOND TAKISHA (LPC)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:TAKISHA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIAMOND
Other - Middle Name:TAKISHA
Other - Last Name:CHINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:539 W COMMERCE ST # 2117
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:512-200-2304
Mailing Address - Fax:
Practice Address - Street 1:406 E HOGAN DR
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-1835
Practice Address - Country:US
Practice Address - Phone:512-200-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health