Provider Demographics
NPI:1255898086
Name:TOMALA, DIANA MARIE (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:TOMALA
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 197TH ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1208
Mailing Address - Country:US
Mailing Address - Phone:708-997-1955
Mailing Address - Fax:
Practice Address - Street 1:13728 W CAREFREE DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8655
Practice Address - Country:US
Practice Address - Phone:708-873-3722
Practice Address - Fax:708-966-4244
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013304101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty