Provider Demographics
NPI:1164616256
Name:HULL, DIANE RITA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RITA
Last Name:HULL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:RITA
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9077 SHADY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1301
Mailing Address - Country:US
Mailing Address - Phone:301-891-5586
Mailing Address - Fax:301-891-5596
Practice Address - Street 1:9077 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:301-891-5586
Practice Address - Fax:301-891-5596
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD046001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6802419 00Medicaid
MD6802419 01Medicaid
MD6802419 01Medicaid