Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | PC002199 | PA |
NPI | 1003245614 |
---|---|
Provider Name | Linda Dickey |
First Address | Apollo, PA 15613-8711 |
Second Address | Apollo, PA 15613-8711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2013 |
Last Update Date | 04/11/2013 |