Provider Demographics
NPI:1205383320
Name:BELL, DIBA JEAN
Entity Type:Individual
Prefix:
First Name:DIBA
Middle Name:JEAN
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 E ANITA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-3905
Mailing Address - Country:US
Mailing Address - Phone:209-684-6542
Mailing Address - Fax:209-451-0602
Practice Address - Street 1:3120 E ANITA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205
Practice Address - Country:US
Practice Address - Phone:209-451-0315
Practice Address - Fax:209-451-0602
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)