Provider Demographics
NPI:1780194381
Name:DIBBLE, LAUREN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DIBBLE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 CHIPPENDALE DR STE 501
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2553
Mailing Address - Country:US
Mailing Address - Phone:415-322-0520
Mailing Address - Fax:
Practice Address - Street 1:4811 CHIPPENDALE DR STE 501
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2553
Practice Address - Country:US
Practice Address - Phone:415-322-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT123427106H00000X
CAIMF101932106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist