Provider Demographics
NPI:1124165394
Name:KINARD, DIANA G (LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:G
Last Name:KINARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CAMDEN HILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2448
Mailing Address - Country:US
Mailing Address - Phone:770-513-8988
Mailing Address - Fax:770-513-2565
Practice Address - Street 1:190 CAMDEN HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2448
Practice Address - Country:US
Practice Address - Phone:770-513-8988
Practice Address - Fax:770-513-2565
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0019171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1487734372OtherPRACTICE NPI