Individual
DIANE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
4733
MA
101YA0400X
Addiction (Substance Use Disorder) Counselor
445
MA
101YP2500X
Professional Counselor
Primary
4733
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982775011
—
MA
Enumeration date
11/12/2006
Last updated
01/16/2023
Update your record
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