Provider Demographics
NPI:1548421050
Name:WATERS, DIANE (CSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BELLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3142
Mailing Address - Country:US
Mailing Address - Phone:540-542-0200
Mailing Address - Fax:540-542-0318
Practice Address - Street 1:180 GRAFTON LANE
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611
Practice Address - Country:US
Practice Address - Phone:540-542-0200
Practice Address - Fax:540-542-0318
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VALC500779821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VALC50077982OtherLICENSE FOR IND CLINICAL SOCIAL WORKER