Provider Demographics
NPI:1366624678
Name:COOPER-BOLINSKEY, DIANNA RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:RUTH
Last Name:COOPER-BOLINSKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:INDIANA STATE UNIVERSITY
Mailing Address - Street 2:749 CHESTNUT STREET, NURSING BLDG. #422
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47809-0001
Mailing Address - Country:US
Mailing Address - Phone:812-237-2322
Mailing Address - Fax:812-237-8114
Practice Address - Street 1:609 E SURGERY CENTER DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-6815
Practice Address - Country:US
Practice Address - Phone:812-917-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000197A101YA0400X
IN34005099A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)