Provider Demographics
NPI:1689340051
Name:DIETRICH, BETH A (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-9486
Mailing Address - Country:US
Mailing Address - Phone:910-528-2739
Mailing Address - Fax:
Practice Address - Street 1:211 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-9486
Practice Address - Country:US
Practice Address - Phone:910-528-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health