Provider Demographics
NPI:1346242211
Name:MALPASS, DIANE L (LMFT, PSYD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:MALPASS
Suffix:
Gender:F
Credentials:LMFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WEATHERSTONE PKWY
Mailing Address - Street 2:STE. 430
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4495
Mailing Address - Country:US
Mailing Address - Phone:770-592-0150
Mailing Address - Fax:770-592-0971
Practice Address - Street 1:1001 WEATHERSTONE PKWY
Practice Address - Street 2:STE. 430
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4495
Practice Address - Country:US
Practice Address - Phone:770-592-0150
Practice Address - Fax:770-592-0971
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health