Organization
AXIS ALLIANCE NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYMBERLI DIAMOND LPC (CEO)
(804) 687-8558
Entity
Organization
Contact information
Practice address
4800 W HUNDRED RD STE C, CHESTER, VA 23831-1746
(804) 533-2293
(804) 597-0219
Mailing address
5519 BACKWATER TER, NORTH CHESTERFIELD, VA 23234-7732
(804) 687-8558
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
10/06/2022
Last updated
10/06/2022
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