Provider Demographics
NPI:1538250931
Name:ABDO, DIANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:ABDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 JAMESTOWN RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3380
Mailing Address - Country:US
Mailing Address - Phone:757-220-8800
Mailing Address - Fax:757-220-8811
Practice Address - Street 1:1309 JAMESTOWN RD
Practice Address - Street 2:STE. 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3380
Practice Address - Country:US
Practice Address - Phone:757-220-8800
Practice Address - Fax:757-220-8811
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810-001755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5400236Medicaid
VA680000224Medicare ID - Type Unspecified