Provider Demographics
NPI:1093847824
Name:WOLF, DIANE STANTON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:STANTON
Last Name:WOLF
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 1:147 DURWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3219
Mailing Address - Country:US
Mailing Address - Phone:865-691-4289
Mailing Address - Fax:865-531-1962
Practice Address - Street 1:147 DURWOOD RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3219
Practice Address - Country:US
Practice Address - Phone:865-691-4289
Practice Address - Fax:865-531-1962
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000010091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical