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General NPI Number Information
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NPI Number | 1518451822
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Entity Type | Organization
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Legal Business Name | DIANNA BANKS PHD LLC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 12/23/2023
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Provider Practice Location Address
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Address Line | 115 FARLEY CIR STE 113
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City | LEWISBURG
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State | PA
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Zip | 17837-9252
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Country | US
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Telephone | 570-238-0193
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Fax |
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Provider Business Mailing Address
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Address Line | 115 FARLEY CIR STE 113
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City | LEWISBURG
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State | PA
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Zip | 17837-9252
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Country | US
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Telephone | 570-238-0193
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DIANNA MICHELLE BANKS
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Credential |
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Telephone | 570-939-0857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS017290
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License Number State |
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