Provider Demographics
NPI:1265057988
Name:DIETZ, DANIELLE RENEE (LPC)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:RENEE
Last Name:DIETZ
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 1:1687 JORDAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENSON
Mailing Address - State:VA
Mailing Address - Zip Code:22656-2113
Mailing Address - Country:US
Mailing Address - Phone:703-347-3193
Mailing Address - Fax:
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-635-4804
Practice Address - Fax:540-636-7171
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional