Provider Demographics
NPI:1265748453
Name:HIRSH, DIANE S (LCPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:HIRSH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 RITCHIE HWY
Mailing Address - Street 2:YWCA
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2461
Mailing Address - Country:US
Mailing Address - Phone:410-626-7800
Mailing Address - Fax:410-626-7312
Practice Address - Street 1:1517 RITCHIE HWY
Practice Address - Street 2:YWCA
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2461
Practice Address - Country:US
Practice Address - Phone:410-626-7800
Practice Address - Fax:410-626-7312
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1969101Y00000X, 101YP2500X
MD101YP1600X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist