Basic Information
| Provider Information | |||||||||
| NPI: | 1124231386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | RACHEL | ||||||||
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| Credential: | MSW,LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1421 HOBNAIL CT | ||||||||
| Address2: | |||||||||
| City: | DAVISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484232203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483430943 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1420 W 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485044827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102380475 | ||||||||
| FaxNumber: | 8102389270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801070730 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.