Provider Demographics
NPI:1588730824
Name:DIEHL, MARTHA LOUISE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LOUISE
Last Name:DIEHL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S ESTES DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2866
Mailing Address - Country:US
Mailing Address - Phone:919-960-0727
Mailing Address - Fax:919-969-0068
Practice Address - Street 1:104 S ESTES DR
Practice Address - Street 2:SUITE 206
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2866
Practice Address - Country:US
Practice Address - Phone:919-960-0727
Practice Address - Fax:919-969-0068
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0012251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2873339Medicare PIN
NC1149GMedicare UPIN