Provider Demographics
NPI:1912416512
Name:DIAMOND, ASHLEY MARIE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 WELLS ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1905
Mailing Address - Country:US
Mailing Address - Phone:509-707-3061
Mailing Address - Fax:
Practice Address - Street 1:4000 SHAKERAG HL STE 100
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4047
Practice Address - Country:US
Practice Address - Phone:509-707-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY900282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2093602Medicaid