Provider Demographics
NPI:1306087168
Name:DISKIN, CAROL JANE (MSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JANE
Last Name:DISKIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:SYLVAN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1618
Mailing Address - Country:US
Mailing Address - Phone:248-854-8627
Mailing Address - Fax:
Practice Address - Street 1:2296 GARLAND ST
Practice Address - Street 2:
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1618
Practice Address - Country:US
Practice Address - Phone:248-854-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010620571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical