Provider Demographics
NPI:1598244196
Name:DIBONGE, JOSLINE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JOSLINE
Middle Name:
Last Name:DIBONGE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 PAYTON WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2730
Mailing Address - Country:US
Mailing Address - Phone:301-728-9095
Mailing Address - Fax:
Practice Address - Street 1:5004 JUDICIAL WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-4807
Practice Address - Country:US
Practice Address - Phone:240-745-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD227611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical