Provider Demographics
NPI:1386452555
Name:DIAMONDZ IN A ROUGH LLC
Entity type:Organization
Organization Name:DIAMONDZ IN A ROUGH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LATASHA
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-R
Authorized Official - Phone:804-301-1129
Mailing Address - Street 1:8712 PROCTORS RUN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2757
Mailing Address - Country:US
Mailing Address - Phone:804-301-1129
Mailing Address - Fax:
Practice Address - Street 1:8712 PROCTORS RUN DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-2757
Practice Address - Country:US
Practice Address - Phone:804-301-1129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health