Healthcare Provider Details

I. General information

NPI: 1609997097
Provider Name (Legal Business Name): DIANE GASKIN PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 J N PEASE PL
CHARLOTTE NC
28262-4504
US

IV. Provider business mailing address

PO BOX 5441
CONCORD NC
28027-1507
US

V. Phone/Fax

Practice location:
  • Phone: 704-796-7734
  • Fax:
Mailing address:
  • Phone: 704-796-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3493
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: