Provider Demographics
NPI:1831126135
Name:NIEBURG, DINAH HAYS (PHD)
Entity Type:Individual
Prefix:MS
First Name:DINAH
Middle Name:HAYS
Last Name:NIEBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 ROSE HILL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5159
Mailing Address - Country:US
Mailing Address - Phone:434-977-0033
Mailing Address - Fax:434-220-3335
Practice Address - Street 1:1110 ROSE HILL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5159
Practice Address - Country:US
Practice Address - Phone:434-977-0033
Practice Address - Fax:434-220-3335
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002889103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1831126135OtherVALUEOPTIONS
VA1831126135OtherVIRGINIA PREMIER
VA081721MOtherOPTIMA FAMILY CARE
VA081721MOtherSENTARA BEHAVIORAL HEALTH
VA208464OtherANTHEM BLUE CROSS BLUE SH