Provider Demographics
NPI:1477528982
Name:DIGLIO, DAVID TRAVIS (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TRAVIS
Last Name:DIGLIO
Suffix:
Gender:M
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 204-151
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9584
Mailing Address - Country:US
Mailing Address - Phone:770-910-0577
Mailing Address - Fax:
Practice Address - Street 1:5000 RESEARCH CT
Practice Address - Street 2:SUITE 725
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6609
Practice Address - Country:US
Practice Address - Phone:770-910-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-18
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7880101YM0800X
GACSW0037981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ49267Medicare UPIN
FLZ089BYMedicare ID - Type Unspecified99262
FLZ089BZMedicare ID - Type Unspecified99262B
GA511I800011Medicare PIN