Provider Demographics
NPI:1649445206
Name:SPERRY, DIANE C
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:SPERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:SPERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10475 MEDLOCK BRIDGE RD
Mailing Address - Street 2:BUILDING 300; SUITE 315
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4433
Mailing Address - Country:US
Mailing Address - Phone:678-935-9567
Mailing Address - Fax:678-935-9568
Practice Address - Street 1:10475 MEDLOCK BRIDGE RD
Practice Address - Street 2:BUILDING 300; SUITE 315
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4433
Practice Address - Country:US
Practice Address - Phone:678-935-9567
Practice Address - Fax:678-935-9568
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003160103TC0700X
AL652103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling