Healthcare Provider Details

I. General information

NPI: 1871614487
Provider Name (Legal Business Name): DIANA MASSO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SHREWSBURY ST
CHARLESTON WV
25301-1211
US

IV. Provider business mailing address

841 SOMERSET DR
CHARLESTON WV
25302-2737
US

V. Phone/Fax

Practice location:
  • Phone: 304-541-9820
  • Fax: 855-815-7553
Mailing address:
  • Phone: 304-541-9820
  • Fax: 855-815-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1797
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: