Provider Demographics
NPI:1386022853
Name:JUSTUS, DIANE (LICDC-CS)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. ROUTE 104
Mailing Address - Street 2:
Mailing Address - City:CHILLOCOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601
Mailing Address - Country:US
Mailing Address - Phone:740-774-7050
Mailing Address - Fax:
Practice Address - Street 1:16149 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9701
Practice Address - Country:US
Practice Address - Phone:740-774-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH933627101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)