Provider Demographics
NPI:1902510043
Name:DIACK, NICHOLAS (RP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DIACK
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 FILLMORE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1544
Mailing Address - Country:US
Mailing Address - Phone:720-900-5501
Mailing Address - Fax:
Practice Address - Street 1:1633 FILLMORE ST STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1544
Practice Address - Country:US
Practice Address - Phone:720-900-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health