Provider Demographics
NPI:1568907749
Name:PROST, DIANE MCCARTHY (MED, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MCCARTHY
Last Name:PROST
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10522 ROSEHAVEN ST APT 214
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2862
Mailing Address - Country:US
Mailing Address - Phone:314-640-1530
Mailing Address - Fax:636-898-4758
Practice Address - Street 1:10522 ROSEHAVEN ST APT 214
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2862
Practice Address - Country:US
Practice Address - Phone:314-640-1530
Practice Address - Fax:636-898-4758
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013187101YP2500X
MO2011037455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional