Provider Demographics
NPI:1376376228
Name:DIAZ, ADAM A (RBT, MHA)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RBT, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-9293
Mailing Address - Country:US
Mailing Address - Phone:931-551-6131
Mailing Address - Fax:
Practice Address - Street 1:1024 FUJI LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8800
Practice Address - Country:US
Practice Address - Phone:931-551-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-369308106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician