Provider Demographics
NPI:1962467449
Name:HAN, DIANE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:HAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 INNSLAKE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6772
Mailing Address - Country:US
Mailing Address - Phone:804-282-4000
Mailing Address - Fax:804-800-4533
Practice Address - Street 1:4200 INNSLAKE DR STE 300
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6772
Practice Address - Country:US
Practice Address - Phone:804-282-4000
Practice Address - Fax:804-800-4533
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003467101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor