Provider Demographics
NPI:1356787949
Name:WARDE, DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WARDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 H ST
Mailing Address - Street 2:SUITE E BOX 1
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6695
Mailing Address - Country:US
Mailing Address - Phone:707-498-3263
Mailing Address - Fax:707-498-3263
Practice Address - Street 1:101 H ST STE E
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6695
Practice Address - Country:US
Practice Address - Phone:707-498-3263
Practice Address - Fax:707-443-3204
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health