Provider Demographics
NPI:1619332749
Name:SMITH, DIANE L (LPCC-S)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4294
Mailing Address - Country:US
Mailing Address - Phone:614-315-0440
Mailing Address - Fax:614-315-0440
Practice Address - Street 1:230 N SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1632
Practice Address - Country:US
Practice Address - Phone:614-315-0440
Practice Address - Fax:614-315-0440
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health