Provider Demographics
NPI:1790149383
Name:DIMMERLING, REBECCA (LAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DIMMERLING
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12823 MURPHY GROVE TER
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4318
Mailing Address - Country:US
Mailing Address - Phone:703-304-7233
Mailing Address - Fax:
Practice Address - Street 1:23330 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-9704
Practice Address - Country:US
Practice Address - Phone:301-366-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist