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General NPI Number Information
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NPI Number | 1235522442
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Entity Type | Individual
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Provider Name | BETHANY JOANNA DEITZ MS, BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 3905 INDEPENDENCE BLVD STE B
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City | WILMINGTON
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State | NC
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Zip | 28412-2472
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Country | US
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Telephone | 948-222-4968
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Fax |
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Provider Business Mailing Address
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Address Line | 125 BOYDTON PLANK DR
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City | STEPHENS CITY
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State | VA
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Zip | 22655-4512
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Country | US
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Telephone | 540-771-7254
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133000596
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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