Provider Demographics
NPI:1528630373
Name:DIASPORA THERAPY GROUP
Entity type:Organization
Organization Name:DIASPORA THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNNE LIZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LMFT
Authorized Official - Phone:858-771-4387
Mailing Address - Street 1:5938 PRIESTLY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8847
Mailing Address - Country:US
Mailing Address - Phone:858-771-4387
Mailing Address - Fax:
Practice Address - Street 1:5938 PRIESTLY DR STE 103
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-8847
Practice Address - Country:US
Practice Address - Phone:858-771-4387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COUNTY CHILD COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-12
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty