Provider Demographics
NPI:1831115716
Name:DIEFFENBAUGHER, AUDREY M (LPC)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:M
Last Name:DIEFFENBAUGHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:MARIE
Other - Last Name:DIEFFENBAUGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:91 CARMEL RD FL 2
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5943
Mailing Address - Country:US
Mailing Address - Phone:513-706-3931
Mailing Address - Fax:
Practice Address - Street 1:87 15TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3548
Practice Address - Country:US
Practice Address - Phone:304-233-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004177101YM0800X, 101YP2500X
WV2569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health