Provider Demographics
NPI:1417076563
Name:ROBERT B DIBBLE
Entity Type:Organization
Organization Name:ROBERT B DIBBLE
Other - Org Name:ALPINE CENTER FOR COUNSELING AND RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:DIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PSYCHOLOGIST
Authorized Official - Phone:760-873-4357
Mailing Address - Street 1:375 E LINE ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3566
Mailing Address - Country:US
Mailing Address - Phone:760-873-4357
Mailing Address - Fax:760-873-7446
Practice Address - Street 1:375 E LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3566
Practice Address - Country:US
Practice Address - Phone:760-873-4357
Practice Address - Fax:760-873-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140001AP261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA003336OtherBLUE CROSS ID
CA003336OtherBLUE CROSS ID