Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY10075 | CA |
NPI | 1003875592 |
---|---|
Provider Name | Joan Dittrich |
First Address | Napa, CA 94559-3333 |
Second Address | Napa, CA 94559-3333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 08/07/2007 |