Provider Demographics
NPI:1609962125
Name:KING, DIANA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:KING
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 1:10700 BALLANTRAYE DR
Mailing Address - Street 2:STE 104
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4700
Mailing Address - Country:US
Mailing Address - Phone:540-479-2211
Mailing Address - Fax:540-301-0500
Practice Address - Street 1:10700 BALLANTRAYE DR
Practice Address - Street 2:STE 104
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4700
Practice Address - Country:US
Practice Address - Phone:540-479-2211
Practice Address - Fax:540-301-0500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA144491OtherKEY CARE, FEDERAL BC/BS
VA73437800OtherMAGELLAN, VALUE OPTIONS
VAM546OtherCAREFIRST
VA144491OtherKEY CARE, FEDERAL BC/BS