Provider Demographics
NPI:1063715134
Name:KNOWLTON, DIANE M (LCPC)
Entity type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:M
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FRANKLIN ST
Mailing Address - Street 2:1ST FLOOR BACK
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6340
Mailing Address - Country:US
Mailing Address - Phone:207-740-6072
Mailing Address - Fax:
Practice Address - Street 1:40 BALL PARK RD
Practice Address - Street 2:
Practice Address - City:SABATTUS
Practice Address - State:ME
Practice Address - Zip Code:04280-4246
Practice Address - Country:US
Practice Address - Phone:207-375-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional