Provider Demographics
NPI:1174998975
Name:DEITZ, KALA MARIE (LCSWA)
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:MARIE
Last Name:DEITZ
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:KALA
Other - Middle Name:MARIE
Other - Last Name:FRANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL RD
Mailing Address - Street 2:CALLER BOX C-268
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719
Mailing Address - Country:US
Mailing Address - Phone:828-497-9163
Mailing Address - Fax:828-497-1723
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:CALLER BOX C-268
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:828-497-1723
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP009909104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker