Provider Demographics
NPI:1649837626
Name:WARGO, DIANE B (LCDCIII)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:B
Last Name:WARGO
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:B
Other - Last Name:TOMASEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:838 COBURN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1459
Mailing Address - Country:US
Mailing Address - Phone:330-812-3118
Mailing Address - Fax:330-208-2136
Practice Address - Street 1:380 S PORTAGE PATH
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2326
Practice Address - Country:US
Practice Address - Phone:330-315-4901
Practice Address - Fax:330-434-7885
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161785101YA0400X
OHLCDCIII162573101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0351895Medicaid