Provider Demographics
NPI:1205903622
Name:ROSS, DIANE M (MS, LCPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 S POINT DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-5107
Mailing Address - Country:US
Mailing Address - Phone:847-524-7540
Mailing Address - Fax:847-524-7540
Practice Address - Street 1:2200 W HIGGINS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-2428
Practice Address - Country:US
Practice Address - Phone:847-885-7790
Practice Address - Fax:847-524-7540
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health