Provider Demographics
NPI:1649769084
Name:DIPPOLD, NATHANIEL (LCPC)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:DIPPOLD
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910C MERIDIAN WAY APT 34
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6892
Mailing Address - Country:US
Mailing Address - Phone:814-594-8734
Mailing Address - Fax:
Practice Address - Street 1:4910C MERIDIAN WAY APT 34
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6892
Practice Address - Country:US
Practice Address - Phone:814-594-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10385101YP2500X
MDLGP8595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional