Doctor Name: | MS. DIANE SPADE |
NPI Number: | 1073648143 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA., LPC |
License Number: | 6401010032 |
Business Practice Address: | 908 2nd St Menominee, MI - 498583245 |
Business Phone Number: | 9068649830 |
Business Fax Number: | 9068649831 |
Mailing Address: | 908 2nd St, MENOMINEE |
State: | MI |
Postal Code: | 498583245 |
Phone Number: | 9068649830 |
Fax Number: | 9068649831 |
NPI Enumeration Date: | 02/22/2007 |
NPI Last Update Date: | 02/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6401010032 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |