MEDICARE: MS. JOAN BOWEN DIBIANCO CAC1, CSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710103665	VA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC11147	DC

General Provider Information

NPI Number	:	1366193823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN BOWEN DIBIANCO CAC1, CSAC

Provider Business Mailing Address
First Line	:	4914 30TH PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-1016
Country	:	US
Telephone Number	:	202-413-1242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 NATIONAL DR
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1105
Country	:	US
Telephone Number	:	301-453-5174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2022
Last Update Date	:	01/15/2022

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