Provider Demographics
NPI:1578376109
Name:RHOADS, DIAMOND BREEZE
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:BREEZE
Last Name:RHOADS
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 1:530 E MCDOWELL RD # 107495
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1549
Mailing Address - Country:US
Mailing Address - Phone:520-505-2810
Mailing Address - Fax:602-581-3026
Practice Address - Street 1:2090 N KOLB RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4149
Practice Address - Country:US
Practice Address - Phone:520-505-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician