Individual
MS. E DIANE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LCSW
Contact information
Practice address
509 W WASHINGTON BLVD, FORT WAYNE, IN 46802-2917
(260) 422-3034
(260) 422-3691
Mailing address
509 W WASHINGTON BLVD, FORT WAYNE, IN 46802-2917
(260) 422-3034
(260) 422-3691
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
34002561A
IN
101YM0800X
Mental Health Counselor
35001087A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183262
BC-BS
IN
Enumeration date
07/18/2006
Last updated
07/09/2007
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