Individual
DEIDRE DETLOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1518 AIRPORT RD, HINESVILLE, GA 31313-9439
(912) 559-5536
Mailing address
616 UNION ST, BRUNSWICK, GA 31520-8213
(912) 269-5009
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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