Provider Demographics
NPI:1336695246
Name:DIDUCK, DIANA (MS, BCBA, LPC-I)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DIDUCK
Suffix:
Gender:F
Credentials:MS, BCBA, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 ELSBY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3113
Mailing Address - Country:US
Mailing Address - Phone:214-728-9485
Mailing Address - Fax:
Practice Address - Street 1:8100 LOMO ALTO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6530
Practice Address - Country:US
Practice Address - Phone:214-351-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74979101YP2500X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional