Provider Demographics
NPI:1912065624
Name:DOSS, DIANNE MOORE (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:MOORE
Last Name:DOSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 SHELBY STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-2824
Mailing Address - Country:US
Mailing Address - Phone:502-875-4499
Mailing Address - Fax:502-875-2655
Practice Address - Street 1:506 SHELBY STREET
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2824
Practice Address - Country:US
Practice Address - Phone:502-875-4499
Practice Address - Fax:502-875-2655
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3231041C0700X
KYKY-0378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist