Healthcare Provider Details

I. General information

NPI: 1285171884
Provider Name (Legal Business Name): DIANN ELDER LICDC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2017
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E STATE ST STE D
ATHENS OH
45701-1870
US

IV. Provider business mailing address

231 DELCOURT DR
SPRINGFIELD OH
45506-3417
US

V. Phone/Fax

Practice location:
  • Phone: 740-326-6110
  • Fax:
Mailing address:
  • Phone: 937-360-8314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1600631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: