Provider Demographics
NPI:1003800889
Name:SPRING, DIANA LYNN (MALLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:SPRING
Suffix:
Gender:F
Credentials:MALLP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:CHILDRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 772263
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-0428
Mailing Address - Country:US
Mailing Address - Phone:989-494-4613
Mailing Address - Fax:248-605-3525
Practice Address - Street 1:2127 UNIVERSITY PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5928
Practice Address - Country:US
Practice Address - Phone:517-705-3667
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361004181103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0995781OtherHEALTHPLUS
MIP108958490OtherBCBS
6224176OtherDBH