Healthcare Provider Details

I. General information

NPI: 1801702725
Provider Name (Legal Business Name): JONATHAN BLAIR DIAMOND LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3478 ROLLING ACRES RD
MILTON FL
32571-9307
US

IV. Provider business mailing address

3478 ROLLING ACRES RD
MILTON FL
32571-9307
US

V. Phone/Fax

Practice location:
  • Phone: 850-384-5148
  • Fax:
Mailing address:
  • Phone: 850-384-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: