Provider Demographics
NPI:1760655104
Name:VANDEVEER, DIANA DAWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:DAWN
Last Name:VANDEVEER
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 1:111 S SHERRIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3221
Mailing Address - Country:US
Mailing Address - Phone:502-894-9822
Mailing Address - Fax:
Practice Address - Street 1:111 S SHERRIN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3221
Practice Address - Country:US
Practice Address - Phone:502-894-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical