Provider Demographics
NPI:1477978377
Name:DIEFENBACH, SHELLEY (MA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:DIEFENBACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2272
Mailing Address - Country:US
Mailing Address - Phone:404-919-4563
Mailing Address - Fax:
Practice Address - Street 1:1875 OLD ALABAMA RD
Practice Address - Street 2:SUITE 625
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2272
Practice Address - Country:US
Practice Address - Phone:404-919-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health