Provider Demographics
NPI:1821646324
Name:PALMER, DIANE (CAC-AD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8901
Mailing Address - Country:US
Mailing Address - Phone:800-867-2395
Mailing Address - Fax:443-410-0842
Practice Address - Street 1:2324 WEST ZION RD.
Practice Address - Street 2:SUIT 112
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:800-867-2395
Practice Address - Fax:410-443-0842
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)