Provider Demographics
NPI:1346758109
Name:DITZLER, DARIA
Entity Type:Individual
Prefix:MS
First Name:DARIA
Middle Name:
Last Name:DITZLER
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:PO BOX 1394
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-1394
Mailing Address - Country:US
Mailing Address - Phone:540-368-8087
Mailing Address - Fax:540-368-8059
Practice Address - Street 1:10707 SPOTSYLVANIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2682
Practice Address - Country:US
Practice Address - Phone:540-368-8087
Practice Address - Fax:540-368-8059
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician