Provider Demographics
NPI:1922813807
Name:DIAMBRA, JOEL FOSTER
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:FOSTER
Last Name:DIAMBRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 COMICE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-6822
Mailing Address - Country:US
Mailing Address - Phone:865-414-3356
Mailing Address - Fax:
Practice Address - Street 1:101 DALTON PLACE WAY STE 105
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-4357
Practice Address - Country:US
Practice Address - Phone:865-414-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional