Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 2558 | LA |
NPI | 1003832601 |
---|---|
Provider Name | Mrs. Dianna Lynn Dearden |
First Address | Lake Charles, LA 70601-7077 |
Second Address | Lake Charles, LA 70601-7077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 08/07/2007 |