| NPI | 1295709244 |
|---|---|
| Former Name | DIANA M SOUTHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SD LPC-MH30555) |
| 104100000X Social Worker (Licence: SD 1985) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2022-06-21 |