Healthcare Provider Details

I. General information

NPI: 1275309296
Provider Name (Legal Business Name): RHONDA R DIEDE LBSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 E BROADWAY AVE
BISMARCK ND
58501-5085
US

IV. Provider business mailing address

1928 E AVENUE E
BISMARCK ND
58501-4862
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-0299
  • Fax:
Mailing address:
  • Phone: 170-131-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6365
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1964
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: