Provider Demographics
NPI:1801476288
Name:WOOD, DIANA OLGA (ADDC)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:OLGA
Last Name:WOOD
Suffix:
Gender:F
Credentials:ADDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10177 STATION WAY APT 458
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6861
Mailing Address - Country:US
Mailing Address - Phone:719-291-1257
Mailing Address - Fax:
Practice Address - Street 1:720 S COLORADO BLVD PH
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:719-800-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COADDC0000014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)