Provider Demographics
NPI:1770703324
Name:HARRIS, DIANE MARIE (PSYD, LCP)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LCP
Mailing Address - Street 1:701 27TH ST BLDG 8135
Mailing Address - Street 2:FT. LEE ASAP
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-2707
Mailing Address - Country:US
Mailing Address - Phone:804-734-9601
Mailing Address - Fax:
Practice Address - Street 1:701 27TH ST BLDG 8135
Practice Address - Street 2:FT. LEE ASAP
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-2707
Practice Address - Country:US
Practice Address - Phone:804-734-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1030203Medicaid