Provider Demographics
NPI:1164930293
Name:HUITT, DIANNE (QP,CSAC,NCCPSS)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:
Last Name:HUITT
Suffix:
Gender:F
Credentials:QP,CSAC,NCCPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 TWIN AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-1359
Mailing Address - Country:US
Mailing Address - Phone:704-777-4335
Mailing Address - Fax:980-251-1088
Practice Address - Street 1:176 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4107
Practice Address - Country:US
Practice Address - Phone:980-989-3062
Practice Address - Fax:980-251-1088
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2967101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty