Healthcare Provider Details

I. General information

NPI: 1932020864
Provider Name (Legal Business Name): JULIE ANNE DITTEMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6316 E HIGHWAY 20
LUCERNE CA
95458-7801
US

IV. Provider business mailing address

PO BOX 316
LUCERNE CA
95458-0316
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-5610
  • Fax: 707-600-1325
Mailing address:
  • Phone: 707-998-1800
  • Fax: 707-998-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUDRC19339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: