Provider Demographics
NPI:1669272506
Name:DIEMER, MARK WILLIAM
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:DIEMER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 TAMARACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3805
Mailing Address - Country:US
Mailing Address - Phone:614-202-9359
Mailing Address - Fax:
Practice Address - Street 1:136 NORTHWOODS BLVD STE B-2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4728
Practice Address - Country:US
Practice Address - Phone:614-202-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)