Provider Demographics
NPI:1396319299
Name:EARDLEY, DIANE DOUGLAS (PHD IN CLINICAL PSYC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:DOUGLAS
Last Name:EARDLEY
Suffix:
Gender:F
Credentials:PHD IN CLINICAL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E CARRILLO ST STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-7439
Mailing Address - Country:US
Mailing Address - Phone:805-705-4958
Mailing Address - Fax:
Practice Address - Street 1:324 E CARRILLO ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-7439
Practice Address - Country:US
Practice Address - Phone:805-963-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94024909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health