Provider Demographics
NPI:1245474253
Name:CLINE, DIANA MARIE (LCSW -706 LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MARIE
Last Name:CLINE
Suffix:
Gender:F
Credentials:LCSW -706 LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7282
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-7005
Mailing Address - Country:US
Mailing Address - Phone:307-751-7916
Mailing Address - Fax:
Practice Address - Street 1:425 W LOUCKS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4128
Practice Address - Country:US
Practice Address - Phone:307-751-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW 706101YM0800X, 101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1932229523Medicaid
WY1225003023Medicaid