Individual
MRS. KRISTEN M DIETERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRC
Contact information
Practice address
927 HUNTING HORN WAY W, EVANS, GA 30809-4829
(585) 474-6278
Mailing address
927 HUNTING HORN WAY W, EVANS, GA 30809-4829
(585) 474-6278
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
946
GA
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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