Most Relevant Information
Provider Data
| NPI Number: | 1003321860 |
| Provider Name: | DIAMOND M THAXTON LPMHC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 010830 |
Most Important Dates
| Enumeration Date: | 12/02/2017 |
| Last Updated: | 10/31/2023 |
Provider Practice Location
7000 E GENESEE ST
FAYETTEVILLE
NY
130661131
Practice Location Phone/Fax
| Phone: | 3154464122 |
| Fax: |
Provider Mailing Location
135 RIDER AVE
SYRACUSE
NY
132071111
Provider Mailing Phone/Fax
| Phone: | 3154148558 |
| Fax: |