Provider Demographics
NPI:1740366863
Name:HUGHES, DIANE (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 N ROCK SPRINGS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5236
Mailing Address - Country:US
Mailing Address - Phone:404-876-8454
Mailing Address - Fax:404-876-5239
Practice Address - Street 1:2801 BUFORD HWY NE
Practice Address - Street 2:SUITE 503
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2149
Practice Address - Country:US
Practice Address - Phone:404-320-2050
Practice Address - Fax:404-876-5239
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0015851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBDRJMedicare ID - Type Unspecified