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General NPI Number Information
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NPI Number | 1669983607
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Entity Type | Individual
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Provider Name | RICHARD EDWARD DEISE JR. LGPC
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Gender | Male
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 226 S JEFFERSON ST
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City | FREDERICK
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State | MD
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Zip | 21701-6205
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Country | US
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Telephone | 301-663-6135
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Fax |
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Provider Business Mailing Address
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Address Line | 417 WILLS CREEK DR
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City | BRUNSWICK
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State | MD
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Zip | 21716-1840
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | LGP3137
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License Number State | MD
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