Provider Demographics
NPI:1003541459
Name:CONLEY, DIANE (LADACII, CAP)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LADACII, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 TRIMBLE ST. APT C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210
Mailing Address - Country:US
Mailing Address - Phone:561-506-9966
Mailing Address - Fax:
Practice Address - Street 1:1725-WILMA RUDOLPH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-221-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-009251-2015101YA0400X
TN1270101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)