Provider Demographics
NPI:1649480419
Name:ZEIDWIG, DIANE THERESA (LMFT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:THERESA
Last Name:ZEIDWIG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 SWAYING PINE WAY
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8057
Mailing Address - Country:US
Mailing Address - Phone:386-736-3798
Mailing Address - Fax:386-736-4717
Practice Address - Street 1:324 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4309
Practice Address - Country:US
Practice Address - Phone:386-736-4722
Practice Address - Fax:386-736-4717
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1376102L00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist