Provider Demographics
NPI:1861402299
Name:DIESEN, EMILIE ANN (MA, LMHC, LCMHC)
Entity type:Individual
Prefix:MS
First Name:EMILIE
Middle Name:ANN
Last Name:DIESEN
Suffix:
Gender:F
Credentials:MA, LMHC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9232
Mailing Address - Country:US
Mailing Address - Phone:425-301-6518
Mailing Address - Fax:
Practice Address - Street 1:8 BENNETT RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9232
Practice Address - Country:US
Practice Address - Phone:828-407-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60103655101YM0800X
NC15019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health