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General NPI Number Information
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NPI Number | 1841322302
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Entity Type | Organization
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Legal Business Name | DINAH H NIEBURG, PHD, PLC
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1110 ROSE HILL DR SUITE 201
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-5159
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Country | US
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Telephone | 434-977-0033
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Fax | 434-220-3335
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Provider Business Mailing Address
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Address Line | 1110 ROSE HILL DR SUITE 201
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-5159
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Country | US
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Telephone | 434-977-0033
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Fax | 434-220-3335
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DINAH H NIEBURG
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Credential | PHD
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Telephone | 434-977-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 0810002889
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License Number State | VA
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