Individual
DIANE WEATHERFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4805 VIA VENTURA, MESQUITE, TX 75150-3153
(615) 943-9479
Mailing address
4805 VIA VENTURA, MESQUITE, TX 75150-3153
(615) 943-9479
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
13247
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13247
LPC
TX
Enumeration date
05/11/2022
Last updated
05/11/2022
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