Individual
MR. BRYAN RUSSELL DIETERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
70 CC ALLEN RD, BURNSVILLE, NC 28714-6875
(828) 989-6004
Mailing address
70 CC ALLEN RD, BURNSVILLE, NC 28714-6875
(828) 989-6004
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/26/2007
Last updated
10/05/2010
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