Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 2001021755 | MO |
NPI | 1003028960 |
---|---|
Provider Name | Mrs. Diana Marie Harold |
First Address | Cape Girardeau, MO 63701-2131 |
Second Address | Cape Girardeau, MO 63701-2131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BCBS 181123 | LCSW (01) | MO |