Provider Demographics
NPI:1326754151
Name:DIDDENS, MARK (LMSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DIDDENS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 BROADWAY APT 609
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2767
Mailing Address - Country:US
Mailing Address - Phone:815-541-1741
Mailing Address - Fax:
Practice Address - Street 1:2000 GLEN ECHO RD STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2898
Practice Address - Country:US
Practice Address - Phone:615-649-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14623101YM0800X
IL150.110236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health