Individual
CHANTELLE DEITRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 BERTHA RD STE B, TAOS, NM 87571-7148
(575) 758-4297
Mailing address
422 CAMINO DE LA MERCED, TAOS, NM 87571-5285
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
08/15/2022
Last updated
02/13/2023
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