Healthcare Provider Details

I. General information

NPI: 1760300750
Provider Name (Legal Business Name): DINA LYN DITZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

408 BETHEL RD STE C-2
SOMERS POINT NJ
08244-2184
US

IV. Provider business mailing address

408 BETHEL RD STE C-2
SOMERS POINT NJ
08244-2184
US

V. Phone/Fax

Practice location:
  • Phone: 609-788-0199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00981800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: