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General NPI Number Information
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NPI Number | 1831658913
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Entity Type | Organization
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Legal Business Name | VIRGINIA DIAZ COUNSELING & FAMILY THERAPY PLLC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 200 DOCTORS DR STE C
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6308
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Country | US
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Telephone | 910-546-7647
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Fax |
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Provider Business Mailing Address
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Address Line | 200 DOCTORS DR STE C
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6308
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Country | US
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Telephone | 910-546-7647
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Fax |
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Authorized Official
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Title or Position | MEMBER/ORGANIZER
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Name | MRS. VIRGINIA LEE DIAZ
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Credential | LMFT, LPC
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Telephone | 910-546-7647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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