Provider Demographics
NPI:1316355936
Name:HESS, DIANA (EDD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:HESS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 DEERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4400
Mailing Address - Country:US
Mailing Address - Phone:706-799-3461
Mailing Address - Fax:
Practice Address - Street 1:4325 WASHINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3966
Practice Address - Country:US
Practice Address - Phone:706-799-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional