Provider Demographics
NPI:1003028960
Name:HAROLD, DIANA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIE
Last Name:HAROLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2131
Mailing Address - Country:US
Mailing Address - Phone:573-334-2889
Mailing Address - Fax:573-651-9152
Practice Address - Street 1:2751 THOMAS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2131
Practice Address - Country:US
Practice Address - Phone:573-334-2889
Practice Address - Fax:573-651-9152
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001021755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBCBS 181123OtherLCSW