Provider Demographics
NPI:1215246699
Name:DICK, CARINA HOPE (MED)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:HOPE
Last Name:DICK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71544
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1544
Mailing Address - Country:US
Mailing Address - Phone:907-456-4729
Mailing Address - Fax:
Practice Address - Street 1:912 BARNETTE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4510
Practice Address - Country:US
Practice Address - Phone:907-456-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health