Individual
MARISSA LEE DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
PO BOX 4000, MOUNTAIN HOME, TN 37684-4000
(423) 926-1171
(423) 979-3005
Mailing address
PO BOX 4000, MOUNTAIN HOME, TN 37684-4000
(423) 926-1171
(423) 979-3005
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.116935
IL
Other
Enumeration date
09/29/2025
Last updated
09/29/2025
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