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General NPI Number Information
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NPI Number | 1679116636
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Entity Type | Organization
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Legal Business Name | DIANE FORSE, LCSW, PLLC
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 14 S AUBURN AVE
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City | RICHMOND
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State | VA
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Zip | 23221-2910
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Country | US
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Telephone | 757-603-3997
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Fax |
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Provider Business Mailing Address
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Address Line | 6268 CHELSEA CRES
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1787
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. DIANE M FORSE
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Credential | LCSW
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Telephone | 757-603-3997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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