Provider Demographics
NPI:1225156698
Name:COSTIGAN, DIANE KATHLEEN (CATC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:KATHLEEN
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 HORNBLEND ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4557
Mailing Address - Country:US
Mailing Address - Phone:858-952-3207
Mailing Address - Fax:
Practice Address - Street 1:1966 HORNBLEND ST APT 7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4557
Practice Address - Country:US
Practice Address - Phone:858-952-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040981101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)