Provider Demographics
NPI:1093551509
Name:DITESHEIM, ANNA RUTH (LCSW-A)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:RUTH
Last Name:DITESHEIM
Suffix:
Gender:X
Credentials:LCSW-A
Other - Prefix:
Other - First Name:A.R.
Other - Middle Name:
Other - Last Name:DITESHEIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-A
Mailing Address - Street 1:1051 SHORESIDE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5507
Mailing Address - Country:US
Mailing Address - Phone:704-650-4777
Mailing Address - Fax:
Practice Address - Street 1:620 W LANE ST STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1441
Practice Address - Country:US
Practice Address - Phone:704-650-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0207481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical