Healthcare Provider Details

I. General information

NPI: 1609701390
Provider Name (Legal Business Name): DIVA SALON AND SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROCHESTER HWY STE A1
SENECA SC
29672-2463
US

IV. Provider business mailing address

204 ROANOKE WAY
GREENVILLE SC
29607-5495
US

V. Phone/Fax

Practice location:
  • Phone: 864-614-1227
  • Fax: 864-210-5209
Mailing address:
  • Phone: 864-800-9263
  • Fax: 864-210-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: MARY ANIS HANNA
Title or Position: OWNER
Credential: HANNA
Phone: 864-800-9263