Provider Demographics
NPI:1780127308
Name:DIANE CHANNAS
Entity type:Organization
Organization Name:DIANE CHANNAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANNAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:410-975-0105
Mailing Address - Street 1:277 PENINSULA FARM RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:277 PENINSULA FARM RD
Practice Address - Street 2:SUITE J
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1018
Practice Address - Country:US
Practice Address - Phone:410-975-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD062331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty