Provider Demographics
NPI:1255032934
Name:DIANA EMBLER LCSW
Entity type:Organization
Organization Name:DIANA EMBLER LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-272-2996
Mailing Address - Street 1:2606 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5520
Mailing Address - Country:US
Mailing Address - Phone:207-272-2996
Mailing Address - Fax:
Practice Address - Street 1:2606 MAPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5520
Practice Address - Country:US
Practice Address - Phone:207-272-2996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164679700OtherNPI INDIVIDUAL
ME1164679700OtherNPI INDIVIDUAL