Provider Demographics
NPI:1013254531
Name:SOUTHER, DIANA ALLISON (MS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ALLISON
Last Name:SOUTHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 KING COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2736
Mailing Address - Country:US
Mailing Address - Phone:423-328-1289
Mailing Address - Fax:
Practice Address - Street 1:1745 KING COLLEGE RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2736
Practice Address - Country:US
Practice Address - Phone:423-328-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health