Provider Demographics
NPI:1891918058
Name:CAROTHERS, DIANE S (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:S
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 19TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3124
Mailing Address - Country:US
Mailing Address - Phone:661-493-0033
Mailing Address - Fax:
Practice Address - Street 1:3040 19TH ST STE 6
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3124
Practice Address - Country:US
Practice Address - Phone:661-493-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46677106H00000X
CALMFT46677106H00000X
CAIMF 43342106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist