Provider Demographics
NPI:1356784946
Name:SYKES, DIANE DOLORE (PSYD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:DOLORE
Last Name:SYKES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3879 SPALDING WOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2602
Mailing Address - Country:US
Mailing Address - Phone:678-691-5702
Mailing Address - Fax:
Practice Address - Street 1:5050 RESEARCH CT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6606
Practice Address - Country:US
Practice Address - Phone:678-749-7600
Practice Address - Fax:770-232-9043
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003667103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist