Provider Demographics
NPI:1255109427
Name:BRUSSELL, DIANE (RCC, LCMHC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BRUSSELL
Suffix:
Gender:F
Credentials:RCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 LABONTE DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-7894
Mailing Address - Country:US
Mailing Address - Phone:541-227-3501
Mailing Address - Fax:
Practice Address - Street 1:314 LABONTE DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7894
Practice Address - Country:US
Practice Address - Phone:541-227-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health