Provider Demographics
NPI:1366193823
Name:DIBIANCO, JOAN BOWEN (CAC1, CSAC)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:BOWEN
Last Name:DIBIANCO
Suffix:
Gender:F
Credentials:CAC1, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 30TH PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1016
Mailing Address - Country:US
Mailing Address - Phone:202-413-1242
Mailing Address - Fax:
Practice Address - Street 1:3919 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1105
Practice Address - Country:US
Practice Address - Phone:301-453-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103665101YA0400X
DCCAC11147101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)