Provider Demographics
NPI:1982715728
Name:BLACK, DIANE N (LPC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:N
Last Name:BLACK
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 1:115 MCPHERSON DR
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-3213
Mailing Address - Country:US
Mailing Address - Phone:409-892-3030
Mailing Address - Fax:409-385-4525
Practice Address - Street 1:1333 W MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3090
Practice Address - Country:US
Practice Address - Phone:214-239-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX18949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health