Provider Demographics
NPI:1790310209
Name:PROCTOR, DIANA MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W THARPE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5300
Mailing Address - Country:US
Mailing Address - Phone:561-802-8782
Mailing Address - Fax:
Practice Address - Street 1:1000 W THARPE ST STE 7
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5300
Practice Address - Country:US
Practice Address - Phone:850-551-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical