Provider Demographics
NPI:1619854569
Name:CHADWICK, DIANE ELAINE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ELAINE
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 E STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5969
Mailing Address - Country:US
Mailing Address - Phone:740-366-7303
Mailing Address - Fax:
Practice Address - Street 1:621 BROAD ST SW STE 2F
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8120
Practice Address - Country:US
Practice Address - Phone:740-366-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)