Provider Demographics
NPI:1013111434
Name:JOHANNING, DIANE (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:JOHANNING
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 S PRESIDENT ST APT 304
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2891
Mailing Address - Country:US
Mailing Address - Phone:630-665-1255
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD STE 900
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4521
Practice Address - Country:US
Practice Address - Phone:630-665-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional