Individual
DIANE MARGARET VAN CORNEWAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW LISAC
Contact information
Practice address
1215 N BEAVER ST, FLAGSTAFF MEDICAL CENTER, FLAGSTAFF, AZ 86001-3126
(928) 213-6415
(928) 213-6409
Mailing address
1215 N BEAVER ST, FLAGSTAFF MEDICAL CENTER, FLAGSTAFF, AZ 86001-3126
(928) 213-6415
(928) 213-6409
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-10581
AZ
101YM0800X
Mental Health Counselor
Primary
LCSW-10760
AZ
Other
Enumeration date
06/17/2013
Last updated
06/17/2013
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