Provider Demographics
NPI:1194042903
Name:SMITH, DIANA HAACK (LPC)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:HAACK
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:349 SILVERSMITH LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0868
Mailing Address - Country:US
Mailing Address - Phone:704-589-6633
Mailing Address - Fax:704-841-8319
Practice Address - Street 1:1145 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6518
Practice Address - Country:US
Practice Address - Phone:704-849-0686
Practice Address - Fax:704-815-1972
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC7453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional