Provider Demographics
NPI:1700933470
Name:KERN, DIANE (MFT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 N MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4692
Mailing Address - Country:US
Mailing Address - Phone:925-943-5503
Mailing Address - Fax:
Practice Address - Street 1:1372 N MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4692
Practice Address - Country:US
Practice Address - Phone:925-943-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health