Provider Demographics
NPI:1083955280
Name:DEITZLER, ERIN (MED)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DEITZLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 2ND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-1097
Mailing Address - Country:US
Mailing Address - Phone:304-684-2656
Mailing Address - Fax:304-684-2658
Practice Address - Street 1:210 2ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-1097
Practice Address - Country:US
Practice Address - Phone:304-684-2656
Practice Address - Fax:304-684-2658
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor