Provider Demographics
NPI:1922112937
Name:ADAMS, DIANE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19012 103RD PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6602
Mailing Address - Country:US
Mailing Address - Phone:253-852-4699
Mailing Address - Fax:844-848-1265
Practice Address - Street 1:1412 SW 43RD ST STE 240
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4803
Practice Address - Country:US
Practice Address - Phone:253-852-4699
Practice Address - Fax:844-848-1265
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY203189103TC0700X
WAPS00002393103TC0700X
WAPY2393103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602507189OtherUBI
WA202920702OtherEIN
WA202920702OtherEIN