Provider Demographics
NPI:1457504953
Name:SILLENCE, DIANA L (LMHC)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:L
Last Name:SILLENCE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18801 WIMBLEDON CIR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5302
Mailing Address - Country:US
Mailing Address - Phone:813-480-2180
Mailing Address - Fax:
Practice Address - Street 1:6811 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5500
Practice Address - Country:US
Practice Address - Phone:813-480-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-5498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26-3458923OtherVISION 4 FAMILIES, PA