Provider Demographics
NPI:1578796082
Name:PIERCE, DIANA M (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:M
Last Name:PIERCE
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 LAKESIDE PKWY
Mailing Address - Street 2:STE 250
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5935
Mailing Address - Country:US
Mailing Address - Phone:800-849-5502
Mailing Address - Fax:
Practice Address - Street 1:14123 PARK AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1048
Practice Address - Country:US
Practice Address - Phone:708-896-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1471983103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool