Provider Demographics
NPI:1841432192
Name:SPINK, DIANE LYDIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LYDIA
Last Name:SPINK
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 1:4446 GOLF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9190
Mailing Address - Country:US
Mailing Address - Phone:267-614-5323
Mailing Address - Fax:
Practice Address - Street 1:4446 GOLF VIEW DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9190
Practice Address - Country:US
Practice Address - Phone:267-614-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW010446L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007762890001Medicaid