Provider Demographics
NPI:1992587323
Name:DIANA, NINA MARIA (LCSW-C)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MARIA
Last Name:DIANA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1315
Mailing Address - Country:US
Mailing Address - Phone:301-672-7668
Mailing Address - Fax:
Practice Address - Street 1:6301 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1316
Practice Address - Country:US
Practice Address - Phone:301-672-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD081211041C0700X
NV081211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical