Provider Demographics
NPI:1013463884
Name:EDENS, DIANA (LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:EDENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20056 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-6776
Mailing Address - Country:US
Mailing Address - Phone:225-348-4295
Mailing Address - Fax:
Practice Address - Street 1:42382 DELUXE PLZ STE 34
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1236
Practice Address - Country:US
Practice Address - Phone:985-956-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health