Provider Demographics
NPI:1376957209
Name:RIES, DIANA M (LMHC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:RIES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 N 3RD ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5285
Mailing Address - Country:US
Mailing Address - Phone:352-835-0848
Mailing Address - Fax:888-217-4124
Practice Address - Street 1:734 N 3RD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5285
Practice Address - Country:US
Practice Address - Phone:352-835-0848
Practice Address - Fax:888-217-4124
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health