Healthcare Provider Details

I. General information

NPI: 1699349233
Provider Name (Legal Business Name): DIARA BEVERLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 PAM ANN LN
LOTHIAN MD
20711-2600
US

IV. Provider business mailing address

2937 SCARBOROUGH CIR
WINDSOR MILL MD
21244-8064
US

V. Phone/Fax

Practice location:
  • Phone: 443-440-5780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: