Provider Demographics
NPI:1396491585
Name:DIEMERT, ANDREA NOELLE (LMFT, LAADC, ICAADC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NOELLE
Last Name:DIEMERT
Suffix:
Gender:F
Credentials:LMFT, LAADC, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9266 PASCAL CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4633
Mailing Address - Country:US
Mailing Address - Phone:562-206-5444
Mailing Address - Fax:
Practice Address - Street 1:4125 TEMESCAL ST
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7558
Practice Address - Country:US
Practice Address - Phone:562-206-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR10120122101YA0400X
CA130217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty