Provider Demographics
NPI:1497196109
Name:HOLLANDER, DIANE L (PSYD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:HOLLANDER
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E MARIETTA ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-3013
Mailing Address - Country:US
Mailing Address - Phone:770-213-3594
Mailing Address - Fax:770-213-3595
Practice Address - Street 1:140 E MARIETTA ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3013
Practice Address - Country:US
Practice Address - Phone:770-213-3594
Practice Address - Fax:770-213-3595
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
GAPSY003735103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst