Individual
DR. DIANE CASANUEVA ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
277 PIERCE AVE, MACON, GA 31204-2419
(478) 755-0060
(478) 743-3508
Mailing address
277 PIERCE AVE, MACON, GA 31204-2419
(478) 755-0060
(478) 743-3508
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
PST000800
GA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY003112
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
556624291A
—
GA
Enumeration date
01/23/2007
Last updated
06/13/2014
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