Individual
MR. KENNETH DITTMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. S.
Contact information
Practice address
711 EXECUTIVE PL, FAYETTEVILLE, NC 28305-5193
(910) 222-6357
(910) 678-9963
Mailing address
109 BRADFORD AVE, FAYETTEVILLE, NC 28301-5401
(910) 323-2311
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
503
NC
106H00000X
Marriage & Family Therapist
Primary
459
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6107330
—
NC
Enumeration date
10/05/2006
Last updated
03/29/2010
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