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NPI Code Detail

MEDICARE: MRS. POTOULA DIAZ MS, LMHC

MEDICARE: MRS. POTOULA DIAZ MS, LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMH 6104FL

General Provider Information

NPI Number : 1558408344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. POTOULA DIAZ MS, LMHC
Provider Business Mailing Address
First Line : 1340 DEER PATH DR
Second Line :
City : OSTEEN
State : FL
Zip : 32764-9824
Country : US
Telephone Number : 407-474-8992
Fax Number :
Provider Business Practice Location Address
First Line : 136 JULIA ST
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-7713
Country : US
Telephone Number : 386-423-9161
Fax Number : 386-423-3094
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 10/20/2025

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