Provider Demographics
NPI:1902649601
Name:TRASK, DIANE BUMGARNER (LMHC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:BUMGARNER
Last Name:TRASK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BLACKTHORN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7253
Mailing Address - Country:US
Mailing Address - Phone:386-690-2284
Mailing Address - Fax:
Practice Address - Street 1:217 BLACKTHORN LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-7253
Practice Address - Country:US
Practice Address - Phone:386-690-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health