Provider Demographics
NPI:1861849242
Name:DIAZ, DAWNITA (LMSW, CAADC)
Entity type:Individual
Prefix:
First Name:DAWNITA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 BLUFF LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-9141
Mailing Address - Country:US
Mailing Address - Phone:616-566-7946
Mailing Address - Fax:
Practice Address - Street 1:720 E 8TH ST STE 3
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3079
Practice Address - Country:US
Practice Address - Phone:616-566-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-03037101YA0400X
MI68010868841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)