Provider Demographics
NPI:1992910723
Name:DEPARTMENT OF VETERAN AFFAIRS
Entity type:Organization
Organization Name:DEPARTMENT OF VETERAN AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:214-857-0912
Mailing Address - Street 1:610 JAGERA WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4582
Mailing Address - Country:US
Mailing Address - Phone:214-857-0912
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:MH COPPER TEAM 116A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50681104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty