Provider Demographics
NPI:1558722967
Name:HILDEBRAND, DIANE (LPCC-S, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:LPCC-S, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3771
Mailing Address - Country:US
Mailing Address - Phone:740-454-1266
Mailing Address - Fax:740-454-7650
Practice Address - Street 1:601 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3771
Practice Address - Country:US
Practice Address - Phone:740-454-1266
Practice Address - Fax:740-454-7650
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH84073 CS101YA0400X
OHE. 0003269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)