Individual
JACLYN J DITTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S,LPC-A, LCAS-A
Contact information
Practice address
130 PRESTON EXECUTIVE DR STE 102, CARY, NC 27513-8433
(608) 558-1907
Mailing address
1208 BALLENA CIR, CARY, NC 27513-4958
(608) 558-1907
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-24369
NC
101YP2500X
Professional Counselor
Primary
A14059
NC
Other
Enumeration date
07/05/2018
Last updated
07/05/2018
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