=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417753765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIAMOND MILESTONES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2025
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 365 SASKATOON DR
-----------------------------------------------------
City | HOPKINS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29061-8267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-224-7446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 365 SASKATOON DR
-----------------------------------------------------
City | HOPKINS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29061-8267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-224-7446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ERIKA C DIAMOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-222-4744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------