Provider Demographics
NPI:1760662423
Name:HATTOX, DIANE FORD (MSW, LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:FORD
Last Name:HATTOX
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 NARROWS LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1140
Mailing Address - Country:US
Mailing Address - Phone:301-774-4464
Mailing Address - Fax:
Practice Address - Street 1:51 MONROE ST
Practice Address - Street 2:SUITE 804
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2421
Practice Address - Country:US
Practice Address - Phone:301-309-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD060551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD646675Medicare PIN