Provider Demographics
NPI:1518109214
Name:DANKOVICH, DIANE M (MSED, LPC, LSW, NCC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:DANKOVICH
Suffix:
Gender:F
Credentials:MSED, LPC, LSW, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BOARDMAN-CANFIELD RD.
Mailing Address - Street 2:BLDG. D
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-783-9690
Mailing Address - Fax:330-783-9693
Practice Address - Street 1:725 BOARDMAN-CANFIELD RD.
Practice Address - Street 2:BLDG. D
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-783-9690
Practice Address - Fax:330-783-9693
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0006554101Y00000X
LSW S.0014733101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0682971Medicaid
OH0682971Medicaid