Provider Demographics
NPI:1881628469
Name:BAILEY, DIANE LISA (PHD, LPC, CRC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LISA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-7939
Mailing Address - Country:US
Mailing Address - Phone:610-441-3378
Mailing Address - Fax:
Practice Address - Street 1:2209 QUARRY DR
Practice Address - Street 2:SUITE C36
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1155
Practice Address - Country:US
Practice Address - Phone:610-441-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3880101YP2500X
PAPC004216101YM0800X
12561225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105074Medicaid