Healthcare Provider Details

I. General information

NPI: 1831126135
Provider Name (Legal Business Name): DINAH HAYS NIEBURG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ROSE HILL DR SUITE 201
CHARLOTTESVILLE VA
22903-5159
US

IV. Provider business mailing address

1110 ROSE HILL DR SUITE 201
CHARLOTTESVILLE VA
22903-5159
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-0033
  • Fax: 434-220-3335
Mailing address:
  • Phone: 434-977-0033
  • Fax: 434-220-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810002889
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: