Individual
AMANDA MAE DIACZENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LGSW
Contact information
Practice address
218 SENECA DR, MOUNT HOPE, WV 25880-8833
(681) 220-9366
Mailing address
218 SENECA DR, MOUNT HOPE, WV 25880-8833
(681) 220-9366
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00943930
WV
Other
Enumeration date
10/01/2017
Last updated
10/01/2017
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