Provider Demographics
NPI:1538112909
Name:LEIBEL, DIAN MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIAN
Middle Name:MARIE
Last Name:LEIBEL
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 313
Mailing Address - Street 2:722 6TH ST
Mailing Address - City:COVINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47932-0313
Mailing Address - Country:US
Mailing Address - Phone:765-793-7405
Mailing Address - Fax:
Practice Address - Street 1:ILLIANA HEALTH CARE SYSTEM
Practice Address - Street 2:1900 E. MAIN
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-554-5110
Practice Address - Fax:217-554-4813
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical