Individual
KATHLEEN DIAK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1010 LAS LOMAS RD NE, SUITE 4, ALBUQUERQUE, NM 87102-2634
(505) 246-8700
Mailing address
5312 CHESAPEAKE RD NW, ALBUQUERQUE, NM 87120-4569
(505) 890-1305
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-05922
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M-05922
NM SOCIAL WORK LICENSE
NM
Enumeration date
06/19/2006
Last updated
07/08/2007
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