Provider Demographics
NPI:1639113111
Name:WILSON, DIANE E
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:6500 BEATTY DR
Mailing Address - Street 2:APT. Q201
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-4055
Mailing Address - Country:US
Mailing Address - Phone:412-867-5008
Mailing Address - Fax:
Practice Address - Street 1:331 SHAW AVE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2918
Practice Address - Country:US
Practice Address - Phone:412-675-8475
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health