Provider Demographics
NPI:1497734222
Name:WILSON, DIANE LIEB (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LIEB
Last Name:WILSON
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 1:5700 CENTRE AVE
Mailing Address - Street 2:#814
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3743
Mailing Address - Country:US
Mailing Address - Phone:412-480-4659
Mailing Address - Fax:412-661-0880
Practice Address - Street 1:211 N WHITFIELD ST
Practice Address - Street 2:470
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3039
Practice Address - Country:US
Practice Address - Phone:412-661-5970
Practice Address - Fax:412-661-0880
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health