Individual
DR. DIANE LOUISE WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
607 BAXTER ST, FAIRVIEW ASS., JOHNSON CITY, TN 37601
(423) 232-2670
(423) 928-0381
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3696
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PHD 425
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106607
MAGELLAN SUMMIT
—
01
—
119750
ANTHEM PROF TRIGON
—
01
—
334969
VALUEOPTIONS (GROUP)
—
05
—
3689293
—
TN
05
—
3980891
—
TN
01
—
7692240
AETNA
—
Enumeration date
08/31/2006
Last updated
07/21/2022
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