Individual
JILLIAN DIFFENBAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMBT, MBA
Contact information
Practice address
1019 HAY ST, FAYETTEVILLE, NC 28305-5315
(717) 406-5020
Mailing address
5308 CHESAPEAKE RD, FAYETTEVILLE, NC 28311-1537
(717) 406-5020
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LMBT 15047
NC
Other
Enumeration date
07/26/2016
Last updated
01/10/2017
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