Individual
MISS BRALEY NICHOLE DIETZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
106 EDWARDS ST, NEWTON, IL 62448-1736
(618) 783-4154
Mailing address
106 EDWARDS ST, NEWTON, IL 62448-1736
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/20/2021
Last updated
04/20/2021
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