Individual
DIANE IVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
(937) 293-8300
(937) 534-1350
Mailing address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
(937) 293-8300
(937) 534-1350
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
E1287
OH
104100000X
Social Worker
S13067
OH
Other
Enumeration date
10/29/2012
Last updated
10/29/2012
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