Provider Demographics
NPI:1912215062
Name:HOLGUIN, DIANARA ATILANA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIANARA
Middle Name:ATILANA
Last Name:HOLGUIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEEDEE
Other - Middle Name:
Other - Last Name:HOLGUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:9635 PAETZ LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-6672
Mailing Address - Country:US
Mailing Address - Phone:575-405-3043
Mailing Address - Fax:
Practice Address - Street 1:5133 DESERT PARK AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-6624
Practice Address - Country:US
Practice Address - Phone:575-405-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-02371041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1041C0700XMedicaid
NM99076268Medicaid