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General NPI Number Information
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NPI Number | 1366624678
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Entity Type | Individual
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Provider Name | DIANNA RUTH COOPER-BOLINSKEY L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 609 E SURGERY CENTER DR
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City | TERRE HAUTE
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State | IN
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Zip | 47802-6815
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Country | US
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Telephone | 812-917-5091
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Fax |
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Provider Business Mailing Address
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Address Line | INDIANA STATE UNIVERSITY 749 CHESTNUT STREET, NURSING BLDG. #422
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City | TERRE HAUTE
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State | IN
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Zip | 47809-0001
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Country | US
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Telephone | 812-237-2322
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Fax | 812-237-8114
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87000197A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34005099A
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License Number State | IN
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