Provider Demographics
NPI:1922551456
Name:BAHR, DIANE (LCPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BAHR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LANGLEY RD N
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6531
Mailing Address - Country:US
Mailing Address - Phone:410-222-0100
Mailing Address - Fax:410-222-0125
Practice Address - Street 1:8 CHURCH CIR
Practice Address - Street 2:2A 53
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1934
Practice Address - Country:US
Practice Address - Phone:410-222-1491
Practice Address - Fax:410-222-2070
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LC22802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD101Y0000XMedicaid