Provider Demographics
NPI:1003833708
Name:LOTHROP, DIANE B (MS, LLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:B
Last Name:LOTHROP
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38807 ANN ARBOR RD STE 9
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3896
Mailing Address - Country:US
Mailing Address - Phone:313-268-4301
Mailing Address - Fax:734-943-6051
Practice Address - Street 1:38807 ANN ARBOR RD STE 9
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3896
Practice Address - Country:US
Practice Address - Phone:313-268-4301
Practice Address - Fax:734-943-6051
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical