# MRS. KATHLEEN KETZLER DEMIENTIEFF

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1215187505
- **Gender:** F
- **Credential:** T.C., C.D.C.1

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 2920 | AK | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 3432 | AK | — |

## Other

- **Enumeration date:** 09/24/2008
- **Last updated:** 09/24/2008