Provider Demographics
NPI:1235943309
Name:FORD, DIAMOND (LMSW)
Entity type:Individual
Prefix:MS
First Name:DIAMOND
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:DIAMOND
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2816
Mailing Address - Country:US
Mailing Address - Phone:254-370-6802
Mailing Address - Fax:
Practice Address - Street 1:737 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2816
Practice Address - Country:US
Practice Address - Phone:254-370-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126456104100000X
TX115163104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker