Provider Demographics
NPI:1205133881
Name:MARR LONGMIRE, DIANE ELIZABETH (MSW, LMHC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:MARR LONGMIRE
Suffix:
Gender:F
Credentials:MSW, LMHC
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:MARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:811 CLEVELAND AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4210
Mailing Address - Country:US
Mailing Address - Phone:360-474-3072
Mailing Address - Fax:888-538-7694
Practice Address - Street 1:811 CLEVELAND AVE STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4210
Practice Address - Country:US
Practice Address - Phone:360-474-3072
Practice Address - Fax:888-538-7694
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG 60122469104100000X
WALH60266648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA251S00000XMedicaid
WA251B00000XMedicaid
WA251S00000XMedicaid