Provider Demographics
NPI:1942551908
Name:DIVER, DIANE CAROL (LCSW, CAC II)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CAROL
Last Name:DIVER
Suffix:
Gender:F
Credentials:LCSW, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 E 65TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4421
Mailing Address - Country:US
Mailing Address - Phone:912-355-1440
Mailing Address - Fax:912-352-0802
Practice Address - Street 1:835 E 65TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4421
Practice Address - Country:US
Practice Address - Phone:912-355-1440
Practice Address - Fax:912-352-0802
Is Sole Proprietor?:No
Enumeration Date:2012-09-30
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0055451041C0700X
GA1782101YA0400X
GAMSW005849104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker