Provider Demographics
NPI:1174646046
Name:ACKERLEY, DIANA GUARNERA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:GUARNERA
Last Name:ACKERLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E STROOP RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2827
Mailing Address - Country:US
Mailing Address - Phone:937-294-1689
Mailing Address - Fax:937-294-3320
Practice Address - Street 1:305 E STROOP RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2827
Practice Address - Country:US
Practice Address - Phone:937-294-1689
Practice Address - Fax:937-294-3320
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical