Provider Demographics
NPI:1487998027
Name:HEIMSTADT, DIANNA (LCSW)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:HEIMSTADT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 BETTY CT STE A
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4178
Mailing Address - Country:US
Mailing Address - Phone:707-839-1933
Mailing Address - Fax:707-839-1726
Practice Address - Street 1:1560 BETTY CT STE A
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4178
Practice Address - Country:US
Practice Address - Phone:707-839-1933
Practice Address - Fax:707-839-1726
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA992291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor