Healthcare Provider Details

I. General information

NPI: 1306226105
Provider Name (Legal Business Name): LYNIECE DIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date: 06/08/2018
Reactivation Date: 01/30/2019

III. Provider practice location address

2380 SALVIO ST STE 200
CONCORD CA
94520-2193
US

IV. Provider business mailing address

2380 SALVIO ST STE 200
CONCORD CA
94520-2193
US

V. Phone/Fax

Practice location:
  • Phone: 408-881-4498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT87644
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF87644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: