MEDICARE: MISS DIANNA OLSEN MA, CAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADC-002043-2014	FL

General Provider Information

NPI Number	:	1730547183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DIANNA OLSEN MA, CAP

Provider Business Mailing Address
First Line	:	PO BOX 683
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32540-0683
Country	:	US
Telephone Number	:	850-797-5369
Fax Number	:

Provider Business Practice Location Address
First Line	:	22219 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-3227
Country	:	US
Telephone Number	:	844-311-1920
Fax Number	:	850-391-5864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2016
Last Update Date	:	01/31/2016

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