Individual
DR. MANDI FAYE DEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
215 HEDRICK DRIVE, NEWPORT, TN 37821
(423) 623-5301
(423) 625-0808
Mailing address
PO BOX 4000, MOUNTAIN HOME, TN 37684-4000
(423) 926-1171
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-202959
ID
Other
Enumeration date
08/21/2007
Last updated
05/23/2018
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