Basic Information
| Provider Information | |||||||||
| NPI: | 1275583692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIGNON | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 DOTYS MILL RD | ||||||||
| Address2: | |||||||||
| City: | ACUSHNET | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027431201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089957637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 543 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027402766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089845566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 4130 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.