Provider Demographics
NPI:1396940748
Name:WISENBAKER-WILLIAMS, DIANE ELIZABETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:WISENBAKER-WILLIAMS
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 1:10655 COX LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5212
Mailing Address - Country:US
Mailing Address - Phone:214-358-3578
Mailing Address - Fax:214-358-0092
Practice Address - Street 1:5600 W LOVERS LN
Practice Address - Street 2:#317
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-4330
Practice Address - Country:US
Practice Address - Phone:214-883-1129
Practice Address - Fax:214-358-0092
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical