Doctor Name: | DR. MARY DIANE WAY |
NPI Number: | 1508857608 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, LMFT, LCDC |
License Number: | 4667 |
Business Practice Address: | 1811 Burr Oak Ln Adkins, TX - 781012606 |
Business Phone Number: | 8302162263 |
Business Fax Number: | 8302162263 |
Mailing Address: | 1811 Burr Oak Ln, ADKINS |
State: | TX |
Postal Code: | 781012606 |
Phone Number: | 8302162263 |
Fax Number: | 8302162263 |
NPI Enumeration Date: | 10/31/2005 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 4667 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |