Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | IHM12064 | FL |
NPI | 1003221383 |
---|---|
Provider Name | Christiane Dieckman |
First Address | Indian Harbour Beach, FL 32937-4168 |
Second Address | Orlando, FL 32819-9096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 27/08/2016 |