Provider Demographics
NPI:1588874150
Name:DITTNER, CARRIE ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:CARRIE ANNE
Middle Name:
Last Name:DITTNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108B NORTH SALEM ST.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502
Mailing Address - Country:US
Mailing Address - Phone:919-303-0377
Mailing Address - Fax:
Practice Address - Street 1:108B NORTH SALEM ST.
Practice Address - Street 2:SUITE 206
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502
Practice Address - Country:US
Practice Address - Phone:919-303-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2771103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent