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General NPI Number Information
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NPI Number | 1861516569
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Entity Type | Individual
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Provider Name | DIANA RAE LIPPENCOTT MA, LSW, LICDC
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1468 BRICE RD STE A
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-2489
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Country | US
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Telephone | 614-397-0110
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Fax | 614-694-2004
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Provider Business Mailing Address
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Address Line | 221 GLENKIRK DR
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City | BLACKLICK
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State | OH
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Zip | 43004-9464
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Country | US
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Telephone | 614-575-2994
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S0014954
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 954183
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License Number State | OH
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