Provider Demographics
NPI:1851843411
Name:VAN BRUGGEN, DIANA JOYCE (MA, ATR-BC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:JOYCE
Last Name:VAN BRUGGEN
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:JOYCE
Other - Last Name:ZAMRAZIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:494 DOVER POND DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8052
Mailing Address - Country:US
Mailing Address - Phone:614-204-0974
Mailing Address - Fax:
Practice Address - Street 1:547 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2603
Practice Address - Country:US
Practice Address - Phone:614-224-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0600219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional