Provider Demographics
NPI:1154021012
Name:GREIVENKAMP, DIANNA (CT)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:GREIVENKAMP
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 BRIDGETOWN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-4346
Mailing Address - Country:US
Mailing Address - Phone:513-939-0300
Mailing Address - Fax:
Practice Address - Street 1:4805 KLEEMAN GREEN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1991
Practice Address - Country:US
Practice Address - Phone:513-673-5476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2304627-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty