Provider Demographics
NPI:1376786046
Name:GODBOLT-HALL, DIANE
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:GODBOLT-HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:GODBOLT-HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:2132 EATON CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6429
Mailing Address - Country:US
Mailing Address - Phone:184-368-7651
Mailing Address - Fax:184-362-9090
Practice Address - Street 1:2132 EATON CIR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6429
Practice Address - Country:US
Practice Address - Phone:184-368-7651
Practice Address - Fax:184-362-9090
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional