Healthcare Provider Details

I. General information

NPI: 1497213573
Provider Name (Legal Business Name): DIANA ELISE STRAIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633D MEDICAL GROUP 77 NEALY AVENUE
JOINT BASE LANGLEY-EUSTIS VA
23665-2040
US

IV. Provider business mailing address

633D MEDICAL GROUP 77 NEALY AVENUE
JOINT BASE LANGLEY-EUSTIS VA
23655-2040
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-7630
  • Fax:
Mailing address:
  • Phone: 757-225-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009512
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: