Provider Demographics
NPI:1154511749
Name:KRAFT, DIANA LYNNE (LCPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNNE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 HOLLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-2682
Mailing Address - Country:US
Mailing Address - Phone:410-231-2124
Mailing Address - Fax:410-882-1079
Practice Address - Street 1:41660 COURTHOUSE DRIVE, SUITE 201A
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:240-472-3522
Practice Address - Fax:410-882-1079
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD338215000Medicaid