Provider Demographics
NPI:1316921083
Name:DIEKMAN, JEANETTE MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:DIEKMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3993
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-3993
Mailing Address - Country:US
Mailing Address - Phone:704-500-1208
Mailing Address - Fax:704-696-0434
Practice Address - Street 1:484 WILLIAMSON RD
Practice Address - Street 2:SUITE 105/E
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9110
Practice Address - Country:US
Practice Address - Phone:704-500-1208
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3447101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor