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General NPI Number Information
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NPI Number | 1134372006
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Entity Type | Individual
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Provider Name | KELLY DIANTHA ESTLE LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 1504 SPRINGHILL AVE
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City | MOBILE
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State | AL
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Zip | 36604-3207
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Country | US
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Telephone | 251-709-6964
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1002
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City | SATSUMA
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State | AL
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Zip | 36572-1002
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Country | US
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Telephone | 251-709-6964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2034C
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License Number State | AL
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