Healthcare Provider Details

I. General information

NPI: 1346113453
Provider Name (Legal Business Name): DIANA LEIGH SHOMO CANAFAX MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 CENTRAL AVE
BARBOURSVILLE WV
25504-1315
US

IV. Provider business mailing address

PO BOX 219
BARBOURSVILLE WV
25504-0219
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-3331
  • Fax:
Mailing address:
  • Phone: 304-733-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCP00946153
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: