Provider Demographics
NPI:1750337473
Name:BALA, DIANA L (LPCC-S, NCC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:BALA
Suffix:
Gender:F
Credentials:LPCC-S, NCC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:BALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCCS, NCC
Mailing Address - Street 1:4301 DARROW RD STE 3500
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2686
Mailing Address - Country:US
Mailing Address - Phone:330-630-9223
Mailing Address - Fax:
Practice Address - Street 1:4301 DARROW RD STE 3500
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224
Practice Address - Country:US
Practice Address - Phone:330-630-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003695101Y00000X, 101YM0800X
OHE. 0003695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000389863OtherANTHEM