Healthcare Provider Details

I. General information

NPI: 1346803822
Provider Name (Legal Business Name): JENNIFER M DEITZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 STATE AVE STE 101
CARLISLE PA
17013-4457
US

IV. Provider business mailing address

26 STATE AVE STE 101
CARLISLE PA
17013-4457
US

V. Phone/Fax

Practice location:
  • Phone: 717-243-1896
  • Fax: 717-243-5297
Mailing address:
  • Phone: 717-243-1896
  • Fax: 171-243-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: