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STACEY DIETRICH MA

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1902240864

Individual Registrant:
 STACEY  DIETRICH MA
Gender: F
Not Sole Proprietor

Location and contact information for practice:
51 CHILDRENS WAY  ENTERPRISE, FL 32725-8135 US
Tel: 386-668-4774  Fax: 386-668-4486

Contact information for business:
51 CHILDRENS WAY  ENTERPRISE, FL 32725-8135 US
Tel: 386-668-4774  Fax: 386-668-4486

Registration Information:
NPI: 1902240864
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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