Provider Demographics
NPI:1154664761
Name:TILSON, DIANA FOX (LICSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:FOX
Last Name:TILSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:HELENE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:16232 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1520
Mailing Address - Country:US
Mailing Address - Phone:425-224-5333
Mailing Address - Fax:
Practice Address - Street 1:12730 50TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9695
Practice Address - Country:US
Practice Address - Phone:425-224-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA337801041C0700X
WALW606195621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical