| Doctor Name: | DR. DIANE ALICIA TENNIES |
| NPI Number: | 1023168531 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | LC 1572 |
| Business Practice Address: | 115 Franklin St Suite 1a Bangor, ME - 044014936 |
| Business Phone Number: | 2079423635 |
| Business Fax Number: | 2079411933 |
| Mailing Address: | 115 Franklin St, Suite 1a BANGOR |
| State: | ME |
| Postal Code: | 044014936 |
| Phone Number: | 2079423635 |
| Fax Number: | 2079411933 |
| NPI Enumeration Date: | 01/10/2007 |
| NPI Last Update Date: | 04/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | LC 1572 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |