Provider Demographics
NPI:1568267615
Name:HOLDERMAN, DIANA LYNN (MED, LPC, TRCC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:HOLDERMAN
Suffix:
Gender:F
Credentials:MED, LPC, TRCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 LINCHMERE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1812
Mailing Address - Country:US
Mailing Address - Phone:937-694-5956
Mailing Address - Fax:
Practice Address - Street 1:4471 LINCHMERE DRIVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-4541
Practice Address - Country:US
Practice Address - Phone:937-694-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-0003431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health