MEDICARE: DR. DIANE MARIE HARRIS PSY.D., LCP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810003726	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770703324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE MARIE HARRIS PSY.D., LCP

Provider Business Mailing Address
First Line	:	701 27TH ST BLDG 8135
Second Line	:	FT. LEE ASAP
City	:	FORT LEE
State	:	VA
Zip	:	23801-2707
Country	:	US
Telephone Number	:	804-734-9601
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 27TH ST BLDG 8135
Second Line	:	FT. LEE ASAP
City	:	FORT LEE
State	:	VA
Zip	:	23801-2707
Country	:	US
Telephone Number	:	804-734-9601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	02/16/2014

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