Provider Demographics
NPI:1720706211
Name:STANLEY, DIAMOND SADE
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:SADE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 KANAS ST
Mailing Address - Street 2:APARTMENT E28
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:323-691-2853
Mailing Address - Fax:
Practice Address - Street 1:92 KANAS ST
Practice Address - Street 2:APT E28
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-9237
Practice Address - Country:US
Practice Address - Phone:323-691-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1481740922101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)