Individual
SANDRA DIETLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
8830 CENTRE ST STE 5, SOUTHAVEN, MS 38671-2609
(662) 253-8324
(662) 253-8336
Mailing address
8830 CENTRE ST STE 5, SOUTHAVEN, MS 38671-2609
(662) 253-8324
(662) 253-8336
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2076
MS
101YP2500X
Professional Counselor
Primary
2076
MS
Other
Enumeration date
09/01/2011
Last updated
03/17/2018
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