Provider Demographics
NPI:1184398075
Name:LASKA, DIANA REBECCA (CHES, CPH, NCPT, CA)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:REBECCA
Last Name:LASKA
Suffix:
Gender:F
Credentials:CHES, CPH, NCPT, CA
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:REBECCA
Other - Last Name:HOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED BEHAVIORA
Mailing Address - Street 1:6 CHARTOM COURT
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23702
Mailing Address - Country:US
Mailing Address - Phone:228-213-4218
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIRCLE, NMCP
Practice Address - Street 2:OUTPATIENT BEHAVIORAL HEALTH CLINIC
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708
Practice Address - Country:US
Practice Address - Phone:757-953-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31001174H00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician