Most Relevant Information
Provider Data
| NPI Number: | 1003577370 |
| Provider Name: | ANDREW WILLIAM DIPASTENA MFT TEMP LICENSE |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/07/2022 |
| Last Updated: | 11/22/2023 |
Provider Practice Location
2200 CHAMBLISS AVE NW
CLEVELAND
TN
373113874
Practice Location Phone/Fax
| Phone: | 4235999347 |
| Fax: |
Provider Mailing Location
725 EVERHART DR NW
CLEVELAND
TN
373111622
Provider Mailing Phone/Fax
| Phone: | 4235440199 |
| Fax: |