Provider Demographics
NPI:1093893968
Name:AIDEUIS, DIANNA LYNN (LCSW, MSW, RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:LYNN
Last Name:AIDEUIS
Suffix:
Gender:F
Credentials:LCSW, MSW, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-5033
Mailing Address - Country:US
Mailing Address - Phone:252-946-1091
Mailing Address - Fax:
Practice Address - Street 1:500 DEXTER ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6318
Practice Address - Country:US
Practice Address - Phone:252-355-3900
Practice Address - Fax:252-355-3995
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138FCOtherBCBS PROVIDER NUMBER
NC6002853Medicaid