Provider Demographics
NPI:1699562264
Name:DITZLER, AUDREY (LAPC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:DITZLER
Suffix:
Gender:
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 S MOUNT JOY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2860
Mailing Address - Country:US
Mailing Address - Phone:717-824-2265
Mailing Address - Fax:
Practice Address - Street 1:5006 E TRINDLE RD # U-101
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3647
Practice Address - Country:US
Practice Address - Phone:717-243-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC001236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health