Provider Demographics
NPI:1376695791
Name:DIBBLE, MRNA TRACY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MRNA
Middle Name:TRACY
Last Name:DIBBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 5TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3031
Mailing Address - Country:US
Mailing Address - Phone:704-332-9034
Mailing Address - Fax:704-373-1604
Practice Address - Street 1:601 E 5TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3031
Practice Address - Country:US
Practice Address - Phone:704-332-9034
Practice Address - Fax:704-373-1604
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0021271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical