Provider Demographics
NPI:1891936852
Name:DIANE LATIMER, PSY.D., P.C.
Entity Type:Organization
Organization Name:DIANE LATIMER, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:336-834-0145
Mailing Address - Street 1:3843 ATTUCKS DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065
Mailing Address - Country:US
Mailing Address - Phone:614-553-7815
Mailing Address - Fax:336-834-0149
Practice Address - Street 1:3843 ATTUCKS DR.
Practice Address - Street 2:SUITE B
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065
Practice Address - Country:US
Practice Address - Phone:614-553-7815
Practice Address - Fax:336-834-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC120080OtherVALUE OPTIONS
NC0312LOtherBLUE CROSS BLUE SHIELD
NC6000011Medicaid
2818319Medicare UPIN