Provider Demographics
NPI:1831568690
Name:WARE, DIANA W (MS, PLPC)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:W
Last Name:WARE
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30826 LINDER RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-8507
Mailing Address - Country:US
Mailing Address - Phone:225-665-7878
Mailing Address - Fax:225-665-7856
Practice Address - Street 1:6835 BAYOU PAUL RD
Practice Address - Street 2:
Practice Address - City:SAINT GABRIEL
Practice Address - State:LA
Practice Address - Zip Code:70776-5608
Practice Address - Country:US
Practice Address - Phone:225-931-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60072433Medicaid