Individual
ANGELA DAWN DIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW, LICDC
Contact information
Practice address
220 S BREIEL BLVD, SUITE A, MIDDLETOWN, OH 45044-5158
(513) 423-3327
(513) 423-3676
Mailing address
220 S BREIEL BLVD, SUITE A, MIDDLETOWN, OH 45044-5158
(513) 423-3327
(513) 423-3676
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I7092
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11661621
CAQH CREDENTIALING
OH
Enumeration date
12/29/2006
Last updated
01/20/2010
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