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General NPI Number Information
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NPI Number | 1639899214
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Entity Type | Individual
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Provider Name | MELODY DIEHL MA
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 819 W 21ST ST STE 200
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City | NORFOLK
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State | VA
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Zip | 23517-1539
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Country | US
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Telephone | 757-319-4650
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Fax | 757-644-5065
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Provider Business Mailing Address
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Address Line | 819 W 21ST ST STE 200
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City | NORFOLK
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State | VA
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Zip | 23517-1539
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Country | US
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Telephone | 757-319-4650
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Fax | 757-644-5065
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701011761
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License Number State | VA
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