Healthcare Provider Details

I. General information

NPI: 1114374535
Provider Name (Legal Business Name): DIANA CAROLINA MARROQUIN JIMENEZ LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8392 SIX FORKS RD STE 204
RALEIGH NC
27615-3061
US

IV. Provider business mailing address

8392 SIX FORKS RD STE 204
RALEIGH NC
27615-3061
US

V. Phone/Fax

Practice location:
  • Phone: 919-307-1847
  • Fax:
Mailing address:
  • Phone: 252-258-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12288
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12288
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: