| Doctor Name: | DIETRA MONTALVO |
| NPI Number: | 1043290273 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | C0004559 |
| Business Practice Address: | Mcxc Dpc Mho Fort Bragg, NC - 283107301 |
| Business Phone Number: | 9105555555 |
| Business Fax Number: | |
| Mailing Address: | Mcxc Dpc Mho, FORT BRAGG |
| State: | NC |
| Postal Code: | 283107301 |
| Phone Number: | 9105555555 |
| Fax Number: | |
| NPI Enumeration Date: | 01/23/2006 |
| NPI Last Update Date: | 03/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C0004559 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |