Provider Demographics
NPI:1598861353
Name:LONGDON, DIANA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:LONGDON
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 1:535 SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5634
Mailing Address - Country:US
Mailing Address - Phone:406-449-3115
Mailing Address - Fax:406-449-8828
Practice Address - Street 1:535 SADDLE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5634
Practice Address - Country:US
Practice Address - Phone:406-449-3115
Practice Address - Fax:406-449-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000500604Medicaid
MT70360OtherBLUE CROSS/BLUE SHIELD