Provider Demographics
NPI:1861546442
Name:HARRIS, DIANE LOUISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LOUISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:LOUISE
Other - Last Name:HILL HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1106 E DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2015
Mailing Address - Country:US
Mailing Address - Phone:480-820-8635
Mailing Address - Fax:480-947-2110
Practice Address - Street 1:1010 E MCDOWELL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2606
Practice Address - Country:US
Practice Address - Phone:602-955-9059
Practice Address - Fax:602-955-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-101601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical