Provider Demographics
NPI:1427193473
Name:POPP, DIANE JANEL (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:JANEL
Last Name:POPP
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 1:213 WATER AVE NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2298
Mailing Address - Country:US
Mailing Address - Phone:541-908-5011
Mailing Address - Fax:
Practice Address - Street 1:213 WATER AVE NW
Practice Address - Street 2:SUITE 400
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2298
Practice Address - Country:US
Practice Address - Phone:541-908-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical