Provider Demographics
NPI:1447523543
Name:DIETTRICH-CHASTAIN, MICHAEL HENRY (LPC, LCAS-A)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HENRY
Last Name:DIETTRICH-CHASTAIN
Suffix:
Gender:M
Credentials:LPC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 REED ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2729
Mailing Address - Country:US
Mailing Address - Phone:828-260-6224
Mailing Address - Fax:
Practice Address - Street 1:33 ORANGE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2328
Practice Address - Country:US
Practice Address - Phone:828-260-6224
Practice Address - Fax:828-298-4870
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health