Provider Demographics
NPI:1437240330
Name:BURNETT, DIANA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:B
Last Name:BURNETT
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 1:210 WIRT ST SW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-2929
Mailing Address - Country:US
Mailing Address - Phone:703-443-8677
Mailing Address - Fax:
Practice Address - Street 1:210 WIRT ST SW
Practice Address - Street 2:SUITE 301
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2929
Practice Address - Country:US
Practice Address - Phone:703-443-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090040009091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical