Provider Demographics
NPI:1346803822
Name:DEITZ, JENNIFER M (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:DEITZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 STATE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4457
Mailing Address - Country:US
Mailing Address - Phone:717-243-1896
Mailing Address - Fax:171-243-5297
Practice Address - Street 1:26 STATE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4457
Practice Address - Country:US
Practice Address - Phone:717-243-1896
Practice Address - Fax:717-243-5297
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional