Organization
INGRID DIEDEREN PHD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. INGRID MARY DIEDEREN PHD (PRESIDENT)
(828) 253-1445
Entity
Organization
Contact information
Practice address
172 ASHELAND AVE, SUITE D, ASHEVILLE, NC 28801-4005
(828) 253-1445
(828) 253-1456
Mailing address
172 ASHELAND AVE, SUITE D, ASHEVILLE, NC 28801-0172
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
1376
NC
Other
Enumeration date
11/23/2010
Last updated
11/23/2010
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