Provider Demographics
NPI:1851971113
Name:DIBIASO, JACKLIN (LPCMH, NCC)
Entity type:Individual
Prefix:
First Name:JACKLIN
Middle Name:
Last Name:DIBIASO
Suffix:
Gender:F
Credentials:LPCMH, NCC
Other - Prefix:
Other - First Name:JACKLIN
Other - Middle Name:
Other - Last Name:SKIBICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 N SCOTTSDALE RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7630
Mailing Address - Country:US
Mailing Address - Phone:302-224-1400
Mailing Address - Fax:302-224-1402
Practice Address - Street 1:910 S CHAPEL ST STE 102
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3468
Practice Address - Country:US
Practice Address - Phone:877-216-8505
Practice Address - Fax:302-224-1402
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000992101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health