Provider Demographics
NPI:1902978281
Name:WAYNE, DIANE ELIZABETH WATTS (LMHC CAP)
Entity Type:Individual
Prefix:MS
First Name:DIANE ELIZABETH
Middle Name:WATTS
Last Name:WAYNE
Suffix:
Gender:F
Credentials:LMHC CAP
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:WAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3930 VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634
Mailing Address - Country:US
Mailing Address - Phone:813-843-7165
Mailing Address - Fax:813-243-1998
Practice Address - Street 1:1211 N WEST SHORE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4600
Practice Address - Country:US
Practice Address - Phone:813-281-8955
Practice Address - Fax:813-281-2474
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710001022101YA0400X
FLCAP2044101YA0400X
FLMH5285101YM0800X
VA0701002638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional