Provider Demographics
NPI:1699875765
Name:MATHIAS, DIANNE J (MHS, LPC, RPTS)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:J
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:MHS, LPC, RPTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 EMBASSY DRIVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603
Mailing Address - Country:US
Mailing Address - Phone:717-431-2027
Mailing Address - Fax:717-431-2014
Practice Address - Street 1:2173 EMBASSY DRIVE
Practice Address - Street 2:SUITE 255
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603
Practice Address - Country:US
Practice Address - Phone:717-431-2027
Practice Address - Fax:717-431-2014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50064526OtherCAPITAL BLUE CROSS INSURANCE