Individual
DIANA LYNN EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
S/T, MS
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(762) 822-0087
Mailing address
1300 ADIE ST, PHENIX CITY, AL 36867-6125
(762) 822-0087
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/24/2020
Last updated
08/24/2020
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