Healthcare Provider Details

I. General information

NPI: 1982956306
Provider Name (Legal Business Name): MEGAN DITTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SUMMIT RIDGE DR
NEVADA CITY CA
95959-9540
US

IV. Provider business mailing address

13500 SUMMIT RIDGE DR
NEVADA CITY CA
95959-9540
US

V. Phone/Fax

Practice location:
  • Phone: 510-926-2292
  • Fax:
Mailing address:
  • Phone: 510-926-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW79844
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: