Provider Demographics
NPI:1063784056
Name:DIMICELI, GINA (MA, LPCI)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DIMICELI
Suffix:
Gender:F
Credentials:MA, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 HIGHWAY 6 N
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2320
Mailing Address - Country:US
Mailing Address - Phone:281-855-1982
Mailing Address - Fax:281-864-4353
Practice Address - Street 1:8955 HIGHWAY 6 N
Practice Address - Street 2:SUITE 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2320
Practice Address - Country:US
Practice Address - Phone:281-855-1982
Practice Address - Fax:281-864-4353
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68334101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor