Provider Demographics
NPI:1992013544
Name:THIGPEN, DIANN DITTO (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:DITTO
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21101 DALE EVANS PKWY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-9356
Mailing Address - Country:US
Mailing Address - Phone:760-961-1663
Mailing Address - Fax:760-961-6793
Practice Address - Street 1:900 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-9356
Practice Address - Country:US
Practice Address - Phone:909-987-7118
Practice Address - Fax:909-386-0750
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCSW851961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992013544OtherOTHER