Basic Information
| Provider Information | |||||||||
| NPI: | 1952360232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | SHAWNE | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 964 ISABEL DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170427482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172749777 | ||||||||
| FaxNumber: | 7172749815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PC010078 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 387279 | 01 | NH | MVP PIN | OTHER | 14Y007926NH01 | 01 | NH | ANTHEM ACES # | OTHER | 30423181 | 05 | NH | MEDICAID | 103760175 | 05 | PA | MEDICAID | 11362913 | 01 | CAQH | OTHER | 2153905 | 01 | NH | CIGNA BH PIN | OTHER |