| NPI | 1407977697 |
|---|---|
| Former Name | LORI ANN DIAZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301010239) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 6301010239) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301010239) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301010239) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301010239) | |
| 103K00000X Behavior Analyst (Licence: MI 1-12-11395) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: 6301010239) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2012-10-11 |