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General NPI Number Information
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NPI Number | 1992013544
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Entity Type | Individual
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Provider Name | DIANN DITTO THIGPEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 900 E GILBERT ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-9356
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Country | US
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Telephone | 909-987-7118
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Fax | 909-386-0750
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Provider Business Mailing Address
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Address Line | 21101 DALE EVANS PKWY
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City | APPLE VALLEY
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State | CA
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Zip | 92307-9356
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Country | US
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Telephone | 760-961-1663
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Fax | 760-961-6793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW85196
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License Number State | CA
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