Provider Demographics
NPI:1578890349
Name:ADDISON, DIANE C (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:C
Last Name:ADDISON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:BANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8320 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6066
Mailing Address - Country:US
Mailing Address - Phone:317-882-5122
Mailing Address - Fax:941-753-2977
Practice Address - Street 1:222 E OHIO ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2193
Practice Address - Country:US
Practice Address - Phone:877-882-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010761A1041C0700X
FLSW145061041C0700X, 101YM0800X
OHI 07004141041C0700X
OHI.0700414-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health