Basic Information
| Provider Information | |||||||||
| NPI: | 1568124030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ RODRIGUEZ | ||||||||
| FirstName: | PAMELA | ||||||||
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| Credential: | LCASA-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5940 BLUE SKY LN | ||||||||
| Address2: | |||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283487538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044085611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 324 PERSON ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283015736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104380939 | ||||||||
| FaxNumber: | 9104380942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2021 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | NC | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | LCAS-27715 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.