Provider Demographics
NPI:1033635305
Name:HARPER, DIANE (LPCA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SPRINGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9152
Mailing Address - Country:US
Mailing Address - Phone:336-888-9403
Mailing Address - Fax:
Practice Address - Street 1:154 N RENFRO ST STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3879
Practice Address - Country:US
Practice Address - Phone:336-888-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA13062OtherLPCA