Provider Demographics
NPI:1669732616
Name:DITTMAN, ELSIE MARY (LPC)
Entity type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:MARY
Last Name:DITTMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3041 DR MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-4705
Mailing Address - Country:US
Mailing Address - Phone:318-227-3350
Mailing Address - Fax:318-222-2979
Practice Address - Street 1:1514 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3379
Practice Address - Country:US
Practice Address - Phone:318-549-2500
Practice Address - Fax:318-549-2555
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2018-11-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional