Provider Demographics
NPI:1093792772
Name:CANIPE, DIANE ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ELAINE
Last Name:CANIPE
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 1:176 INDEPENDENCE BLVD
Mailing Address - Street 2:STE F
Mailing Address - City:MT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030
Mailing Address - Country:US
Mailing Address - Phone:336-789-4585
Mailing Address - Fax:336-789-4585
Practice Address - Street 1:176 INDEPENDENCE BLVD
Practice Address - Street 2:STE F
Practice Address - City:MT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030
Practice Address - Country:US
Practice Address - Phone:336-789-4585
Practice Address - Fax:336-789-4585
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0025271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0218QOtherBCBS
NC0218QOtherBCBS