Provider Demographics
NPI:1679998926
Name:CHARLTON, DIANA (LPC NBC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:LPC NBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-5513
Mailing Address - Country:US
Mailing Address - Phone:724-396-6926
Mailing Address - Fax:
Practice Address - Street 1:200 JAMES PL
Practice Address - Street 2:SUITE 403
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3445
Practice Address - Country:US
Practice Address - Phone:724-396-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005115101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor