Provider Demographics
NPI:1699375477
Name:RAMBEAU, DIANE CAROL (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CAROL
Last Name:RAMBEAU
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 1:6547 RAMSEY FORD RD
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463-9316
Mailing Address - Country:US
Mailing Address - Phone:410-299-6571
Mailing Address - Fax:
Practice Address - Street 1:6547 RAMSEY FORD RD
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-9316
Practice Address - Country:US
Practice Address - Phone:410-299-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC012821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker