Provider Demographics
NPI:1427194810
Name:WEBB, DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:DIANE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1892
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-1892
Mailing Address - Country:US
Mailing Address - Phone:912-381-0039
Mailing Address - Fax:888-519-1159
Practice Address - Street 1:133 WILL SMITH RD
Practice Address - Street 2:
Practice Address - City:BROXTON
Practice Address - State:GA
Practice Address - Zip Code:31519-3535
Practice Address - Country:US
Practice Address - Phone:912-381-0039
Practice Address - Fax:888-519-1159
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW21411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical