Provider Demographics
NPI:1760629059
Name:WILLIAMS, DIANE S (LAC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:STAPP
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1811 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3001
Mailing Address - Country:US
Mailing Address - Phone:480-831-7566
Mailing Address - Fax:480-962-7671
Practice Address - Street 1:8825 N 23RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4147
Practice Address - Country:US
Practice Address - Phone:602-861-2255
Practice Address - Fax:602-861-2288
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-1493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health