Healthcare Provider Details

I. General information

NPI: 1497480891
Provider Name (Legal Business Name): DIANA ZWANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W WILLIAM CANNON DR STE 6A
AUSTIN TX
78745-5282
US

IV. Provider business mailing address

3080 GRASSLAND LN
KYLE TX
78640-5065
US

V. Phone/Fax

Practice location:
  • Phone: 512-344-9181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number67425
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: