Provider Demographics
NPI:1487311692
Name:GRAHAM, DIANE MICHELLE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MICHELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MICHELLE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, LCSW
Mailing Address - Street 1:18415 E SHARP AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8524
Mailing Address - Country:US
Mailing Address - Phone:509-655-4425
Mailing Address - Fax:
Practice Address - Street 1:18415 E SHARP AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-8524
Practice Address - Country:US
Practice Address - Phone:509-655-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604410711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical