Individual
MR. JUSTIN DEITRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LGPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LGP1399
MD
101YS0200X
School Counselor
—
—
Other
Enumeration date
01/03/2023
Last updated
01/03/2023
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