Provider Demographics
NPI:1578309738
Name:BONN-DAMLE, DIANE CAROL (LMHCA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CAROL
Last Name:BONN-DAMLE
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-2600
Mailing Address - Country:US
Mailing Address - Phone:401-578-9246
Mailing Address - Fax:
Practice Address - Street 1:180 CEDAR HILL DR
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-2600
Practice Address - Country:US
Practice Address - Phone:401-578-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00151-A-101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty