Individual
DIANA MARIE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAS, LCSWA
Contact information
Practice address
2000 NEUSE BLVD, NEW BERN, NC 28560-3449
(252) 633-8204
Mailing address
424 NEW RIVER DR, JACKSONVILLE, NC 28540-6006
(910) 545-9944
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-24929
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-4929
NC
101YM0800X
Mental Health Counselor
Primary
P015340
NC
Other
Enumeration date
03/15/2019
Last updated
08/06/2021
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