Individual
CARLY RAE DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
2513 24TH ST, SAN FRANCISCO, CA 94110-3556
(415) 264-8205
Mailing address
1517 GOLDEN GATE AVE, SAN FRANCISCO, CA 94115-4514
(415) 572-1763
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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