Provider Demographics
NPI:1134480130
Name:CLONMELL, DIANE J (LCPC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:J
Last Name:CLONMELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 E ARBORY CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5554
Mailing Address - Country:US
Mailing Address - Phone:240-338-8115
Mailing Address - Fax:
Practice Address - Street 1:7655 E ARBORY CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5554
Practice Address - Country:US
Practice Address - Phone:240-338-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional