Provider Demographics
NPI:1245483395
Name:VANCLEAVE, DIANE SUE (PHD, MSSW)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:SUE
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:PHD, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 COVERT AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-5617
Mailing Address - Country:US
Mailing Address - Phone:812-475-3420
Mailing Address - Fax:
Practice Address - Street 1:4770 COVERT AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-5617
Practice Address - Country:US
Practice Address - Phone:812-475-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340000182A1041C0700X
IN35001309A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34000182AOtherCLINICAL SOCIAL WORKER
IN35001309AOtherMARRIAGE & FAMILY THERAPIST