Healthcare Provider Details

I. General information

NPI: 1912442526
Provider Name (Legal Business Name): DOUG DIBRIELLE LPCC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DOUG DIBRIELLE LPCC, LMHC

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST STE 939
SAN FRANCISCO CA
94102-1414
US

IV. Provider business mailing address

490 POST ST STE 939
SAN FRANCISCO CA
94102-1414
US

V. Phone/Fax

Practice location:
  • Phone: 617-429-6838
  • Fax: 855-532-9720
Mailing address:
  • Phone: 617-429-6838
  • Fax: 855-532-9720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number21759
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21759
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8027
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8027
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21759
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8027
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: