Provider Demographics
NPI:1467549733
Name:PATTILLO, DIANA ALTHEA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ALTHEA
Last Name:PATTILLO
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:PO BOX 53695
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31995-3695
Mailing Address - Country:US
Mailing Address - Phone:706-507-4762
Mailing Address - Fax:
Practice Address - Street 1:FT BENNING ASAP
Practice Address - Street 2:7950 MARTIN LOOP
Practice Address - City:FT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-0000
Practice Address - Country:US
Practice Address - Phone:706-545-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3846101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)