Individual
MRS. JESSICA L DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1224 LAUREL ST, INDIANAPOLIS, IN 46203-1908
(317) 969-5279
Mailing address
1345 BARTH AVE, INDIANAPOLIS, IN 46203-1822
(317) 432-7247
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
33007906A
IN
101YP2500X
Professional Counselor
33007906A
IN
104100000X
Social Worker
33007906A
IN
1041C0700X
Clinical Social Worker
Primary
33007906A
IN
Other
Enumeration date
01/20/2018
Last updated
01/20/2018
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