Healthcare Provider Details

I. General information

NPI: 1144551953
Provider Name (Legal Business Name): DIANA GAIL HARBOUR L.AC. DIPL.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18478 FOREST RD STE 3
FOREST VA
24551-4302
US

IV. Provider business mailing address

P.O. BOX 2398
FOREST VA
24551
US

V. Phone/Fax

Practice location:
  • Phone: 434-316-9101
  • Fax:
Mailing address:
  • Phone: 540-586-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000570
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: