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General NPI Number Information
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NPI Number | 1104342237
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Entity Type | Individual
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Provider Name | JUSTINE M DIENER O'LEARY LP, HSP-P
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 233A MERCHANTS CIR STE 204
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City | HAMPSTEAD
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State | NC
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Zip | 28443-5419
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Country | US
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Telephone | 910-902-9760
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Fax |
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Provider Business Mailing Address
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Address Line | 988102 NEBRASKA MEDICAL CTR
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City | OMAHA
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State | NE
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Zip | 68198-8102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6214
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License Number State | NC
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