Individual
MS. LAURA JEAN DIFFENDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCC-S
Contact information
Practice address
20525 CENTER RIDGE RD STE 520, ROCKY RIVER, OH 44116-3424
(216) 978-1924
Mailing address
1297 SAINT CHARLES AVE, LAKEWOOD, OH 44107-2532
(216) 978-1924
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
E4139
OH
Other
Enumeration date
07/02/2007
Last updated
09/17/2010
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