Provider Demographics
NPI:1871650549
Name:QUINTANA-BENAVIDEZ, DIANNE (LPC)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:QUINTANA-BENAVIDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:QUINTANA-BENAVIDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1 KALISA WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3508
Mailing Address - Country:US
Mailing Address - Phone:888-948-6789
Mailing Address - Fax:877-345-3501
Practice Address - Street 1:2701 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3869
Practice Address - Country:US
Practice Address - Phone:719-251-4136
Practice Address - Fax:877-345-3501
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional