Provider Demographics
NPI:1992026249
Name:GREEN, DIANE J (LPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:201 BRITTANIA DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5789
Mailing Address - Country:US
Mailing Address - Phone:757-220-3200
Mailing Address - Fax:757-253-4371
Practice Address - Street 1:1657 MERRIMAC TRL
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5624
Practice Address - Country:US
Practice Address - Phone:757-220-3200
Practice Address - Fax:757-253-4371
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701004798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health