| Doctor Name: | DR. MARK WILLIAM DEITRICK |
| NPI Number: | 1174755078 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | PC000115 |
| Business Practice Address: | 229 Portersville Rd Ellwood City, PA - 161172431 |
| Business Phone Number: | 7247529114 |
| Business Fax Number: | 7246573326 |
| Mailing Address: | 2703 W State St, NEW CASTLE |
| State: | PA |
| Postal Code: | 161018671 |
| Phone Number: | 7246573303 |
| Fax Number: | 7246573326 |
| NPI Enumeration Date: | 08/11/2009 |
| NPI Last Update Date: | 08/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PC000115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |