Provider Demographics
NPI:1740406271
Name:PAULK, DIANA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYNN
Last Name:PAULK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5668
Mailing Address - Country:US
Mailing Address - Phone:205-807-5372
Mailing Address - Fax:205-413-8789
Practice Address - Street 1:3499 INDEPENDENCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5668
Practice Address - Country:US
Practice Address - Phone:205-807-5372
Practice Address - Fax:205-413-8789
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1326103T00000X
GA06-1639992103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty