Provider Demographics
NPI:1730547183
Name:OLSEN, DIANNA (MA, CAP)
Entity type:Individual
Prefix:MISS
First Name:DIANNA
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MA, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32540-0683
Mailing Address - Country:US
Mailing Address - Phone:850-797-5369
Mailing Address - Fax:
Practice Address - Street 1:22219 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-3227
Practice Address - Country:US
Practice Address - Phone:844-311-1920
Practice Address - Fax:850-391-5864
Is Sole Proprietor?:No
Enumeration Date:2016-01-31
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-002043-2014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)