Provider Demographics
NPI:1083430326
Name:COLEMAN, DIANE MARIE (TVI)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:TVI
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:YAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5733
Mailing Address - Country:US
Mailing Address - Phone:304-650-0436
Mailing Address - Fax:
Practice Address - Street 1:24 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5733
Practice Address - Country:US
Practice Address - Phone:304-650-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency