Basic Information
| Provider Information | |||||||||
| NPI: | 1447882519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMLIN | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | JONES | ||||||||
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| Credential: | LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4325 E WT HARRIS BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282151938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047747249 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5108 REAGAN DR STE 14 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282061395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043328787 | ||||||||
| FaxNumber: | 7043328788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2020 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A15444 | NC | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 15444 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.