Provider Demographics
NPI:1598985293
Name:EDWARDS, DIANA LYNN (MS,BSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS,BSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 OLD PARIS RD
Mailing Address - Street 2:
Mailing Address - City:WEST TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47885-9027
Mailing Address - Country:US
Mailing Address - Phone:812-242-2244
Mailing Address - Fax:812-242-2210
Practice Address - Street 1:4600 S SPRINGHILL JCT
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4584
Practice Address - Country:US
Practice Address - Phone:812-242-2244
Practice Address - Fax:812-242-2210
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002997A101YA0400X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)