Individual
DIANE WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
180 GRAFTON LANE, BERRYVILLE, VA 22611
(540) 542-0200
(540) 542-0318
Mailing address
120 BELLVIEW AVE, WINCHESTER, VA 22601-3142
(540) 542-0200
(540) 542-0318
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC50077982
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LC50077982
LICENSE FOR IND CLINICAL SOCIAL WORKER
VA
Enumeration date
06/18/2008
Last updated
06/18/2008
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