Provider Demographics
NPI:1437207958
Name:SLADE, DIANE (MFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SLADE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX #891
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559
Mailing Address - Country:US
Mailing Address - Phone:707-592-0346
Mailing Address - Fax:707-259-8606
Practice Address - Street 1:1434 3RD ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559
Practice Address - Country:US
Practice Address - Phone:707-253-4780
Practice Address - Fax:707-259-8606
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist