Provider Demographics
NPI:1932286309
Name:XIQUES, DIANE BARBARA (MA LCMHC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:BARBARA
Last Name:XIQUES
Suffix:
Gender:F
Credentials:MA LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468
Mailing Address - Country:US
Mailing Address - Phone:802-860-8402
Mailing Address - Fax:802-524-7989
Practice Address - Street 1:5 LEMNAH DRIVE
Practice Address - Street 2:NUSI DIANE XIQUES
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-860-8402
Practice Address - Fax:802-524-7989
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006721Medicaid