Provider Demographics
NPI:1407191414
Name:DOROW, DIANE (MA)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:DOROW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:BROYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:16425 266TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-6936
Mailing Address - Country:US
Mailing Address - Phone:425-749-9784
Mailing Address - Fax:425-391-7984
Practice Address - Street 1:16425 266TH AVE SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-6936
Practice Address - Country:US
Practice Address - Phone:425-749-9784
Practice Address - Fax:425-391-7984
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health