Healthcare Provider Details

I. General information

NPI: 1033306196
Provider Name (Legal Business Name): ELAINE N. DIAN PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 AKRON RD
WOOSTER OH
44691-7904
US

IV. Provider business mailing address

PO BOX 518
SMITHVILLE OH
44677-0518
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-3232
  • Fax: 330-202-3879
Mailing address:
  • Phone: 330-202-3870
  • Fax: 330-202-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0002939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: