Basic Information
Provider Information
NPI: 1568587590
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HENNINGTON
FirstName: DAIAN
MiddleName: HAZARD
NamePrefix:  
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 813
Address2:  
City: MONTEREY
State: CA
PostalCode: 939420813
CountryCode: US
TelephoneNumber: 8317961700
FaxNumber:  
Practice Location
Address1: 1441 CONSTITUTION BLVD
Address2: BLDG 400, SUITE 202
City: SALINAS
State: CA
PostalCode: 939063100
CountryCode: US
TelephoneNumber: 8317961700
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/20/2007
LastUpdateDate: 03/04/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000XLCSW25149CAY Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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