Provider Demographics
NPI:1720644610
Name:LOCK, DIAMANTINA (LMFT)
Entity Type:Individual
Prefix:
First Name:DIAMANTINA
Middle Name:
Last Name:LOCK
Suffix:
Gender:F
Credentials:LMFT
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 2427
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93613-2427
Mailing Address - Country:US
Mailing Address - Phone:559-346-7127
Mailing Address - Fax:
Practice Address - Street 1:2540 W SHAW LN STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2700
Practice Address - Country:US
Practice Address - Phone:559-256-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist