Healthcare Provider Details

I. General information

NPI: 1467373472
Provider Name (Legal Business Name): CHRISTINA DIAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 HIGHWAY 20 SE
CONYERS GA
30013-2868
US

IV. Provider business mailing address

341 WYLDEWOOD DR
MCDONOUGH GA
30253-4779
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-4482
  • Fax: 770-922-4640
Mailing address:
  • Phone: 404-242-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001246
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: