Provider Demographics
NPI:1023790250
Name:MCCONNELL, DIANE (LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MCCONNELL
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 1:505 SHEPHERDS WAY
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-7948
Mailing Address - Country:US
Mailing Address - Phone:937-477-6424
Mailing Address - Fax:
Practice Address - Street 1:2335 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2219
Practice Address - Country:US
Practice Address - Phone:937-477-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0007448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional