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1023644465
KRISTEN M DIETERT
EVANS, GA
NPI
1023644465
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: GA 946)
Enumeration Date
2020-03-17
Last Update Date
2020-03-17
Business Address
Mrs. KRISTEN M DIETERT CRC
927 HUNTING HORN WAY W
EVANS, GA 30809-4829
Phone number: 585-474-6278
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Mailing Address
Mrs. KRISTEN M DIETERT CRC
927 HUNTING HORN WAY W
EVANS, GA 30809-4829
Phone number: 585-474-6278
Copy
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