Provider Demographics
NPI:1841322302
Name:DINAH H NIEBURG, PHD, PLC
Entity type:Organization
Organization Name:DINAH H NIEBURG, PHD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:H
Authorized Official - Last Name:NIEBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-977-0033
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002889103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA081721MOtherOPTIMA FAMILY CARE
1831126135OtherVIRGINIA PREMIER
VA208466OtherANTHEM BCBS
VA1831126135OtherVALUE OPTIONS
VA081721MOtherSENTARA BEHAVIORAL HEALTH
VA=========OtherUNITED BEHAVIORAL HEALTH
VA1831126135OtherVALUE OPTIONS