Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | NC | |
N | 101YP1600X | Pastoral Counselor | NC |
NPI | 1104342484 |
---|---|
Provider Name | Doug Dickens |
First Address | Gastonia, NC 28054-4870 |
Second Address | Gastonia, NC 28054-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2017 |
Last Update Date | 17/08/2017 |