Provider Demographics
NPI:1174704027
Name:LOAIS, DIANE HUNTLEY (101YM0800X)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:HUNTLEY
Last Name:LOAIS
Suffix:
Gender:F
Credentials:101YM0800X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 TOWN CRIER DR APT 27
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6851
Mailing Address - Country:US
Mailing Address - Phone:413-629-1253
Mailing Address - Fax:
Practice Address - Street 1:141 NORTH ST STE 3
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4121
Practice Address - Country:US
Practice Address - Phone:413-442-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health