Basic Information
| Provider Information | |||||||||
| NPI: | 1235540550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIBELLA | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 35455 GARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480352236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867925335 | ||||||||
| FaxNumber: | 5867923061 | ||||||||
| Practice Location | |||||||||
| Address1: | 35455 GARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480352236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867925335 | ||||||||
| FaxNumber: | 5867923061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2014 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 6401014718 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | 6401014718 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.