Provider Demographics
NPI:1952185241
Name:DIEGUE GROUP
Entity Type:Organization
Organization Name:DIEGUE GROUP
Other - Org Name:LIFESTYLE PSYCHIATRY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LASHIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-964-5107
Mailing Address - Street 1:202 BLUM CT UNIT 1816
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-8572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6700 RIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3960
Practice Address - Country:US
Practice Address - Phone:973-964-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty