| Doctor Name: | CHRISTIANE DIECKMAN |
| NPI Number: | 1003221383 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | IHM12064 |
| Business Practice Address: | 4680 Lipscomb St Ne 10h Palm Bay, FL - 329052984 |
| Business Phone Number: | 3219517179 |
| Business Fax Number: | |
| Mailing Address: | 1010 Steven Patrick Ave, INDIAN HARBOUR BEACH |
| State: | FL |
| Postal Code: | 329374276 |
| Phone Number: | 3366074458 |
| Fax Number: | |
| NPI Enumeration Date: | 06/25/2014 |
| NPI Last Update Date: | 06/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IHM12064 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |