Provider Demographics
NPI:1295174613
Name:DILLENBECK, NINA BETH (NCC LCPC CAC-AD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:BETH
Last Name:DILLENBECK
Suffix:
Gender:F
Credentials:NCC LCPC CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 YORK ST
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2146
Mailing Address - Country:US
Mailing Address - Phone:443-398-1700
Mailing Address - Fax:
Practice Address - Street 1:605 N BENTZ ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4982
Practice Address - Country:US
Practice Address - Phone:443-398-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1186101YA0400X
MDLC6977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)