Provider Demographics
NPI:1821804113
Name:STUDART, DIEGO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:STUDART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 POPE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-7432
Mailing Address - Country:US
Mailing Address - Phone:910-216-9169
Mailing Address - Fax:
Practice Address - Street 1:250 POPE LAKE RD
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-7432
Practice Address - Country:US
Practice Address - Phone:910-216-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty