Provider Demographics
NPI:1861812042
Name:LASICHAK, DIANE LYNN (LCSW, LCSW-C, CMC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LYNN
Last Name:LASICHAK
Suffix:
Gender:F
Credentials:LCSW, LCSW-C, CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19309 WINMEADE DR
Mailing Address - Street 2:SUITE #334
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20459 OLD GREY PL
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5522
Practice Address - Country:US
Practice Address - Phone:571-333-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040045831041C0700X
MD101531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical