Provider Demographics
NPI:1528504677
Name:HEATH, DIANA GERTRUD (LPC)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:GERTRUD
Last Name:HEATH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:GERTRUD
Other - Last Name:LEAVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:31312 PINE PLACE
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970
Mailing Address - Country:US
Mailing Address - Phone:703-498-8677
Mailing Address - Fax:
Practice Address - Street 1:31312 PINE PLACE
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970
Practice Address - Country:US
Practice Address - Phone:703-498-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional