Doctor Name: | CAROL DIECKMANN |
NPI Number: | 1013140151 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCC |
License Number: | 0113631 |
Business Practice Address: | 2702 Placita Chueco Santa Fe, NM - 875055254 |
Business Phone Number: | 5056038138 |
Business Fax Number: | |
Mailing Address: | 1092 Early St, Suite #2 SANTA FE |
State: | NM |
Postal Code: | 875051662 |
Phone Number: | 5056038138 |
Fax Number: | |
NPI Enumeration Date: | 08/24/2009 |
NPI Last Update Date: | 06/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0113631 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |