Provider Demographics
NPI:1912172628
Name:DANIEL C BIBER, PHD, PA
Entity Type:Organization
Organization Name:DANIEL C BIBER, PHD, PA
Other - Org Name:DILWORTH PSYCHOTHERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BIBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-334-4300
Mailing Address - Street 1:1717 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4735
Mailing Address - Country:US
Mailing Address - Phone:704-334-4300
Mailing Address - Fax:704-334-8639
Practice Address - Street 1:1717 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4735
Practice Address - Country:US
Practice Address - Phone:704-334-4300
Practice Address - Fax:704-334-8639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL C BIBER PHD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000184Medicaid
NC2810629Medicare PIN