Provider Demographics
NPI:1932501236
Name:DITTMAR COUNSELING SERVICES, L.L.C.
Entity type:Organization
Organization Name:DITTMAR COUNSELING SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DITTMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:724-853-6942
Mailing Address - Street 1:4936 ROUTE 30
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2343
Mailing Address - Country:US
Mailing Address - Phone:724-610-7726
Mailing Address - Fax:724-420-5739
Practice Address - Street 1:4936 ROUTE 30
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2343
Practice Address - Country:US
Practice Address - Phone:724-610-7726
Practice Address - Fax:724-420-5739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006295L1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023288140001Medicaid