Kenneth Dittmar, M. S.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

459 Issued in NC

Practice address

711 Executive PL
Fayetteville, NC 28305-5193

Phone

(910) 222-6357

Fax

(910) 678-9963

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269820800000",
    "number": "1457447765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 BRADFORD AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015401",
            "telephone_number": "910-323-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 EXECUTIVE PL",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055193",
            "telephone_number": "910-222-6357",
            "fax_number": "910-678-9963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITTMAR",
        "first_name": "KENNETH",
        "name_prefix": "Mr.",
        "credential": "M. S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2010-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "503",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107330",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Marriage & Family Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.