Provider Demographics
NPI:1881147585
Name:ALLEN, DIANE (LMSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9725
Mailing Address - Country:US
Mailing Address - Phone:810-350-9111
Mailing Address - Fax:844-273-3696
Practice Address - Street 1:11831 MAPLE RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-8487
Practice Address - Country:US
Practice Address - Phone:810-350-9111
Practice Address - Fax:844-273-3696
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010797531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical