Provider Demographics
NPI:1992973507
Name:ANTHONY, DIANE CARRIN (MS)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CARRIN
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HUXLEY RD
Mailing Address - Street 2:SUITE NUMBER 6
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3185
Mailing Address - Country:US
Mailing Address - Phone:865-776-1814
Mailing Address - Fax:
Practice Address - Street 1:118 HUXLEY RD
Practice Address - Street 2:SUITE NUMBER 6
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3185
Practice Address - Country:US
Practice Address - Phone:865-776-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health