Provider Demographics
NPI:1093725038
Name:VERSFELT, DIANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:VERSFELT
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 1:3212 CUTSHAW AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-5024
Mailing Address - Country:US
Mailing Address - Phone:804-353-3324
Mailing Address - Fax:804-353-4498
Practice Address - Street 1:3212 CUTSHAW AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-5024
Practice Address - Country:US
Practice Address - Phone:804-353-3324
Practice Address - Fax:804-353-4498
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health