Provider Demographics
NPI:1942468228
Name:PAYNE, DIANE L (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:PAYNE
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 1:3111 SPRINGBANK LN
Mailing Address - Street 2:SUITE I
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3372
Mailing Address - Country:US
Mailing Address - Phone:704-540-0625
Mailing Address - Fax:704-540-2762
Practice Address - Street 1:3111 SPRINGBANK LN
Practice Address - Street 2:SUITE I
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3372
Practice Address - Country:US
Practice Address - Phone:704-540-0625
Practice Address - Fax:704-540-2762
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1615103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2812489AMedicare PIN