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General NPI Number Information
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NPI Number | 1780710657
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Entity Type | Organization
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Legal Business Name | DIANE M.MCKISSICK, L.C.S.W.-C., LTD
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 41201 FRIENDSHIP CT
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City | MECHANICSVILLE
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State | MD
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Zip | 20659-3877
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Country | US
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Telephone | 301-373-7750
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Fax | 301-373-2626
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Provider Business Mailing Address
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Address Line | 41201 FRIENDSHIP CT
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City | MECHANICSVILLE
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State | MD
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Zip | 20659-3877
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Country | US
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Telephone | 301-373-7750
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Fax | 301-373-2626
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Authorized Official
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Title or Position | OWNER
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Name | DIANE M MCKISSICK
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Credential | LSCW-C
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Telephone | 301-373-7750
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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 | 07889
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License Number State | MD
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