Provider Demographics
NPI:1952967853
Name:WITZEL, DIANE (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WITZEL
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 1:220 N SAGE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-4061
Mailing Address - Country:US
Mailing Address - Phone:269-697-3317
Mailing Address - Fax:269-697-3317
Practice Address - Street 1:800 E MILHAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002
Practice Address - Country:US
Practice Address - Phone:269-249-7179
Practice Address - Fax:269-459-7149
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011041941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical