Healthcare Provider Details

I. General information

NPI: 1073432118
Provider Name (Legal Business Name): SHEENA DIAZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 CLAIRMONT RD
DECATUR GA
30030-1228
US

IV. Provider business mailing address

431 OMNIA CT
LAWRENCEVILLE GA
30044-2213
US

V. Phone/Fax

Practice location:
  • Phone: 678-661-6304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017034
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: