Provider Demographics
NPI:1619030582
Name:DITTMEIER, ERIC G (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:DITTMEIER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 W BOULEVARD DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1913
Mailing Address - Country:US
Mailing Address - Phone:703-360-1291
Mailing Address - Fax:
Practice Address - Street 1:205 S WHITING ST
Practice Address - Street 2:SUITE 601
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7100
Practice Address - Country:US
Practice Address - Phone:703-360-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health