Provider Demographics
NPI:1801646914
Name:DIAZ, JAMIE (LLMSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6415
Mailing Address - Country:US
Mailing Address - Phone:734-968-6525
Mailing Address - Fax:
Practice Address - Street 1:19000 ST JOES PKWY
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1339
Practice Address - Country:US
Practice Address - Phone:734-743-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68511159901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical